Your Most Important 12-Lead EKG Lesson

I’m going to kick off this post with its most important lesson – you can’t learn about schizophrenics from a textbook. You have got to interact with some schizophrenics. So, you cannot learn 12-lead EKG interpretation from a textbook. You can’t. You can learn rhythm strip interpretation, but when it comes to 12-lead EKGs, the findings are so subtle, you need to have someone mentor you closely. For the first year and a half of my PA career, I showed every EKG to a supervising doctor — 100% of the time — because the stakes are too high. Then, when I started working as a hospitalist, it took another year before I got really proficient at reading EKGs.

Do THIS with a 12-lead EKG ID-100162272
If you are feeling unsure about a 12-lead EKG when assessing someone with chest pain, never hesitate to get that EKG to someone smarter than you. Show the EKG to someone else. Do not carry a coffin by yourself. Get someone else involved. Know when to talk to somebody else – in the beginning, that is 100% of the time. Even as an ER guy, and I have taught 12-lead EKG interpretation for years, there are still EKGs that I look at and say, “I want a second opinion on this, and I’m getting this to a cardiologist right away.” The smart ER doctors do that. You’re smart, so do not hesitate to do two things:

  • Get it to someone smarter than you to get another opinion 
  • When you are in doubt, keep burning EKGs

Remember, an EKG is just a picture. It is a static picture where acute coronary presentations are dynamic. They will get worse. If you are unsure, keep doing EKGs every five minutes until it blossoms out. If you have someone who is going to an ST segment elevation MI, it will get worse, and you can tell that by doing serial EKGs.

The two safety nets of EKGs
When in doubt, get the EKG to someone smarter than you; do not carry a coffin by yourself. Do serial EKGs. These two safety nets can make a big impact on your career.

Looking for more emergency medicine lessons? I’ve put together some EM CME that will help you recall key information at critical times. Check out our CME shop and reach out to us with any questions.

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John Bielinski, Jr., MS PAC is a practicing emergency medicine clinician, and has been lecturing nationally for more than ten years, teaching the tactics that have proven invaluable in his career as a medical professional.