Procedural Skills for Medical Students
12 lead Electrocardiogram (ECG) Interpretation
Objectives:
1. Understand the principles of ECG tracings
in relation to the electrical activity of the
heart.
2. Understand how to properly place the
electrodes and differentiate between
leads.
3. Be able to interpret common abnormal
rhythms including sinus tachycardia,
sinus bradycardia, ventricular
tachycardia, ventricular fibrillation,
supraventricular tachycardia, pulseless
electrical activity, asystole, ST elevation and ST depression.
Material to review prior to lab: Dynamic Cardiac Rhythm Simulator
Indications for obtaining a 12 lead ECG:
1.
2.
3.
4.
5.
6.
7.
Chest pain or discomfort
Shortness of breath
Syncope or near syncope
Palpitations
Any heart rate less than 50 or greater than 150
A feeling of impending doom
Diaphoresis unexplained by ambient temperature, unexplained general weakness, or
unexplained nausea and vomiting.
8. Suspected diabetic ketoacidosis
9. Any suspected drug overdose or metabolic derangement
10. An unconscious patient (excluding cardiac arrest)
11. Return of spontaneous circulation, post cardiac arrest
Contraindications:
1. There are no identified contraindications for obtaining a 12 lead ECG. However, the
practitioner should ensure that someone who is trained to interpret the tracing is
available for accurate and reliable interpretation.
Equipment: HPS, electrodes
Instructional Procedure & Endpoints:
1. Learners will be oriented to Human Patient Simulator (HPS) and equipment in ASTEC.
2. Instruction will be given on lead placement and direction of electrical activity resulting
in ECG tracings.
3. Learners will demonstrate correct lead placement on HPS.
4. Instructor will review common ECG tracings and characteristics with learners.
5. Learners will be able to identify 7 out of 10 of the following rhythms on the HPS: sinus
rhythm, sinus tachycardia, sinus bradycardia, sinus arrhythmia, atrial flutter, atrial
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Procedural Skills for Medical Students
fibrillation, supraventricular tachycardia, ventricular tachycardia, ventricular
fibrillation, and asystole.
6. Learners will be able to identify 3 out of 4 of the following EKG findings: cardiac
ischemia (ST segment elevation versus ST segment depression), premature atrial
contractions, and premature ventricular contractions.
References:
SkillStat Learning Inc. (2005). The six second ECG: Dynamic cardiac rhythm simulator.
Retrieved from http://www.skillstat.com/Flash/ECGSim531.html
White, R.D. & Harris, G.D. (2011). Office electrocardiograms. In J.L. Pfenninger, & G.C. Fowler
(Eds.), Procedures for Primary Care, 3rd Ed (579-584). Philadelphia: Elsevier Mosby.
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