As a physician assistant, the stakes of interpretation of a 12 lead ECG is high. No doubt. If we misread a deflection, this could mean life or death. Literally. So, as a PA that has a few credit hours of EKG interpretation in school, how do we not get burned?

Get smart. Period. Get educated. Do you know the EKG changes of an inferior wall STEMI? How about pericarditis? A LBBB? Ischemia of the circumflex artery? If it’s your job to evaluate a 12-lead EKG, you need to know this information in detail. In the meantime, there are two safety nets.

The first safety net is to show someone else. The god of emergency medicine is humility. The physicians do it. If a doctor isn’t sure of a 12 lead EKG, they will fax it to cardiology. We need to do the same thing. If you are not highly confident, have a physician look at the EKG.

Also, understand the changes on a 12 lead EKG that are sinister will be dynamic. We need to understand that an EKG is a static picture, but an ischemic event is a movie. You can’t take a picture of a movie and feel you have a clear picture. Multiple pictures are needed to get a valid impression of the big picture. So, do at least two EKGs. This will allow us to pick up subtle changes, and it tells the world we understand ischemic changes are dynamic.

Remember the two safety nets. Show someone else and “do two.”