EKG Basics

Okay.
All right. See people jumping on. Hi Guys. Welcome to EKG basics. As y'all jump on, just let me know you're on, you know, where you're from and feel free to go ahead. As you jump on, go ahead and tell me what kind of EKG rhythms or stuff that you are most uncomfortable with, what you really, really, really want to know so I can make sure I prioritize. So go ahead and tell me what you want me to focus on once I run through the basics cause I want to make sure I hit the highlights. Give it another. Hi Guys. Welcome. Welcome. [inaudible] 30 seconds.
Okay.
Just reading in general. Okay. Reading a strip.
Okay.
Awesome. Awesome. Okay, cool. So we're gonna get started. So I want to run through just some basics of EKG first before I talk about specific rhythms. Um, hey, often when we do the survey at the end, will you put that in there? Um, and that way chance who's in charge of tutoring sessions can kind of prioritize that. Um, so I want to talk about some basics of EKG so you know what the heck you're looking at. We'll talk about the six step method for interpretation and then we can run through kind of just some of the basic things that you might see, some of the most common rhythms and kind of how to identify them. There are a couple of rhythms that I will tell you, you should never have to do the six step method on. You should see them from across the room and you should be like, holy Moly, that's a problem and you should be running to the patient's room.
Okay. So, um, there's a couple that I'm going to show you that look like that, that I want to make sure that you get. So first thing to know is when you're looking at an EKG graph, you're going to see something like this. Of course, with a rhythm on it, right? I'm gonna try to hold it still. You see something like that. So you see there's dark lines and there's light lines or there's thick lines and thin lines. There's big boxes in little boxes, basically is what you're seeing. And we'll talk about it that way. We'll talk about large boxes and small boxes. And so what you'll see for every large box, if this is a large box, large, they're still pretty small. Um, then inside of every large box there are 25 small boxes. So one, two, three, four, five small boxes across, and one, two, three, four, five small boxes vertically.
Okay? So what I want you to know, the vertical axis, which is sometimes called the y axis, measures our, um, milliamps or amplitude. And the amplitude is going to tell us how much electricity is happening in that moment. So it has nothing to do. Remember the EKG has everything to do with electricity and nothing to do with mechanical pumping action. So the reason the wave form for the atria is smaller than the wave form for the ventricles is not because the ventricles are stronger, but because the atrium are literally physically smaller. So there's less electricity going through them than the amount of electricity going through the ventricles. Okay? So that's why the tricolor wave forms are a lot bigger and taller because a lot more electricity happening. So vertical access tells us our amplitude, how much electricity are we seeing? Then the horizontal axis or the x axis tells us our time measured in seconds.
Okay? So that's our time measured in seconds. So amplitude up and down, time left and right. Okay. Now we have big boxes and we have small boxes, right? So the big box one large box, go ahead and put it in the chat if you know is how many seconds is one large box? Yeah, asking you're on it. 0.2 seconds. Okay. 0.2 seconds or 0.2 seconds. And so if a large box is 0.2 seconds and there's five small boxes inside the large box, how many seconds is one small box? Yeah, 0.04 so y'all what's 20 divided by five four, right? So 0.04 seconds in one small box. So this is important to know because a couple of the rhythms you're going to look at in a couple of the things are gonna need to analyze. You're going to have to be able to say how many seconds is that?
Um, and so you might look at a p a p r interval. So from the beginning of the P to the R and say how long is that? Because if it's longer than 20 seconds, we're going to have issues. A QRS complex needs to be less than 0.12 or less than point 12 and so if it's wider than that, we're going to have issues. So it's important to know how many seconds are in each box so that she can really understand what you're looking at as far as times and wave forms and things like that. So first thing I want you to understand, large boxes point to small box is 0.04 everyone happy with that?
Any questions about that? As far as amplitude goes, I'll be honest in, in general nursing, we're typically not looking at amplitude except for one thing. And that is the s t segment. So if we've seen more than two small boxes with the St segment, we're going to start to get a little bit worried. So let's talk about that. Let's talk about what the different waveforms are. So we have a wave form that looks like something like this is our rudimentary, does it mean you can't tell? I have this, I have an EKG rhythm on my necklace. I'm kind of a cardiac nerd. I kind of love the heart. Um, so you could do a burn first for them and I don't know. Yeah, you guys can see left, right? So the very, very first wave form we get is going to be our p wave. And what does that p wave indicate for us? What does that P wave showing us?
Give you a stack and then I'll give you a hint. P Austin, you are on this. So the p wave is atrial de polarization. Notice I don't say atrial contraction. Remember the EKG is only telling me what the electricity is doing, not what the actual heart muscle is doing physically, mechanically. So atrial depolarization, which if everything's working wonderfully, we'll get you atrial contraction. But specifically what it's showing us as atrial depolarization. So the next wave forms that we have is the QRS complex. Now not everybody has a Q wave. This is it. The little secret for you, not everyone has a QA a ways is if the wave form goes down first, that is a queue. Otherwise we don't have one. The first up wave is our, our, our, our, our, our, I'm not a pirate, I swear. So the first upgrade has that r and then the down rave is going to be r s. So the QRS complex, um, we look at it as a whole as opposed to individual waves. So what does the QRS complex tell us? What are we looking at electrically with the QRS complex? I'm gonna write it while you guys are thinking.
Yeah. Then Tricolor depolarization. So remember we talked about amplitude and the amount of electricity that's happening. The ventricles are just physically larger, so you're gonna have all the way down the ventricles up the Birkin g fibers, lots of electricity happening in the ventricles. The atrial just physically smaller, so it's just not as much electricity happening. Atria ventricles. Okay. Lastly, a farm we have on here is iron two wave t waves. So P QRS. So what does our t waves show us electrically? What does our t wave telling us? Yeah, been trickier re polarization. So notice what's missing. What's missing is atrial repolarization. Well, atrial repolarization basically happens during this QRS and so the electrical activity in the ventricles tends to just override the, the relaxation, the repolarization of the Atria. And so we don't see it. So atrial depolarization, ventricular depolarization, ventricular repolarization, remember that during the Tricolor repolarization those ventricles can't contract again electrically.
It's just part of our, the way the active potential works, right? So if we were to try to start a new action potential during this t wave, we could actually cause some major problems because it's going to kind of short circuit the electricity. And so I'm going to tell you about an interval here that we always want to look at because it can tell us we might be at risk for that problem. That's short circuit, couple of intervals that we want to look at. Feminine, another color. So you guys can see first interval that we look at is the p r interval. So from P to R, and that goes literally from the beginning of the P to the r wave.
Yeah.
Um, Austin, I'll answer that in just a second when we talk about it. Good thinking. So p r so the PR interval tells me how long does it take from the time that my essay node starts, the signal to the time my ab node starts the signal. Remember the Ab node normally will pass for a little bit. That's what you're seeing right here. That's that pause. It'll pass for a little bit to allow the ventricles to fill. And then it goes. And so p r tells me how long that's taking. And that should always be to do this. So I don't accidentally erase it. Less than 0.2 seconds. Less than 0.2 seconds. Okay, next little segment is this little part right here. And we call that the s t it's an FTC segment. It's not an interval. We're not looking at time. We're just looking at where that segment lies.
We want that segment to be straight across on the same little baseline is everything else. Okay? If we start to see this s t segment creep up, then we call that s t elevation. An s t elevation is indication of elevation. Telling me is happening to my portal with my poor little patient with ft elevation, a Stemi, a heart attack, st elevation, myocardial infarction, not good. So we always look at bat and if it goes up by two small boxes and we have a problem, then the last little interval, and this is where Austin talk about what you're talking about, tasting is from MCU
to the end of the t Q to the end of the T. And we call that the QT interval QT interval. So from the time the ventricles start to contract to the time they are done relaxing, now we're talking deep polarization. Repolarization right? We're talking electricity. So from the time they start to depolarize to the time they finish re polarizing because remember until they done re polarizing, we don't want to try anything. Anything else, right? So if this starts to prolong and we start to see my T-wave actually be out here instead, then we're probably closer and closer to where that next heartbeat is. Gonna try to start, right? Because our essay node is like, Hey, I got this some 60 to 80 beats a minute, 60 to a hundred I'm going, I'm chilling. This QT interval starts to prolong that signal comes in where the t wave is and we short circuit the heart.
So to Austin's question is that why we paste on the airwave 100% we pay. So we sync, we're going to sync or cardiovert on the r wave because if we do it later than that we have, we run the risk of short circuiting the heart. If we start to target the heart, there's two of them that you are most likely to see. What are they? If we short short circuit by hitting that t wave, what are the two rhythms are most likely to see the FIB and VTE? Absolutely. So prolonged QT interval increases your risk for V-fib and v Tech. So that's why we always want to pay attention to that. So that's why you'll see like some drugs will actually say it's a risk for prolonged QT. You need to know that because you need to pay attention to it and you see it. Okay. So basics of the rhythm, basics of the boxes that you're going to see. Questions about this. Just this part.
You got a second? All right. So I'm gonna talk you through the six step method for interpretation. I will tell you, we just completely updated and redid our entire EKG course. So not only do we talk you through how to interpret every rhythm, but we're also gonna talk you through what to do about it, which is super exciting. So please feel free to check that out. In fact, while I'm talking about it, I'm going to drop a link here for the very first lesson in the EKG course. So start on the first lesson. Work your way through. There's information just about understanding electrical activity of heart, understanding these waveforms like we just talked about, and then there's a lesson for every major rhythm. So definitely check those out. So six step method to interpretation. Step one always is, uh, is it regular or irregular? So step one is the regularity. Oh my gosh. If I can spell regularity, regular or irregular. So if I have a rhythm in order to check and see if it's regular, I'm just going to draw a basic one here.
I need to look at the distance between my eye waves. Distance between my r waves. Is the distance between my waves consistent all the way across. Then I'm regular. If it's varied with small here, it's big here at smaller it's medium, it's large. Then we know where irregular. Okay. I will tell you nine times out of 10 if you see an irregular heart rate, you're looking at eight Afib, a flutter or a heart block. There's your first [inaudible] irregular eighth of eighth letter or a heart block or obviously the beef. It'd be tax. You guys need to be able to see. So first step is regularity. Second step is at rate rate. Okay? So how fast is it? If you have a six second strip, which most of the time in the hospital you're going to get a six second strip. Um, then you just count.
So if I had my six second strip, I count my rhythms that I have in that six seconds and multiply by 10, that tells me how many I have in 60. It is an estimate. It's not perfect, but it's going to give you a good idea. If you've got seven beats in 10 seconds and you're regular, chances are you've got 70 ish beats in a minute. If you are irregular, that isn't a guarantee, right? Because they may slow way down, they may speedway up because their, they're not consistent with that difference. Every regular, just count your six seconds. Otherwise you may need account for a full minute, um, calculate it that way. Um, and you can also do a small box method if you go to, um, that EKG course, there is a lesson called calculating heart rate. And to actually gives you like four different ways to calculate heart rate on EKG. So what is a normal heart rate? What are we looking for? What would be normal?
Yeah, 60 to 100 in an adult. Absolutely. Good clarification. Pete's higher. A lot of times their heart rates are a lot higher. One 40 could even be normal for a younger child. So 60 to a hundred and adults. Okay. So, um, regularity rate. And then the next thing you're going to look at is your p to Qis ratio. So basically, what are we saying here? What are we saying? Do I have the same number of p waves as I do QRS or do I have a p before every QRS or do I have a qs for every p right? Your goal here is always for this to be one to one. You should have one p ways for one QRS all the way throughout. If you start to have more p waves than QRSs, chances are you're looking at a heart block, um, or again, some sort of atrial flutters and sort of atrial rhythm. Okay. Um, and if you have, uh, more QRSs than you have some sort of ventricular with them. Right? So pdqs ratio is the next thing. Next thing we look at is the PR interval. So again, timing on the PR intervals should be less than 0.2 seconds.
Yeah.
Okay. If I see consistent 0.16 seconds on every single um, complex, I'm good to go. I'm normal. I have no issues as far as that goes. Okay. If you start to see that your PR interval is changing or your PR interval is longer, you're looking at a heart block and we're going to talk about heart blocks in a second. Okay. Um, number five. Number five is the QRS complex. I want to know is it normal, narrow or wide? Narrow, wide, narrow or normal would be less than 0.1, two seconds. And anything above that is considered wide. If you have a wide complex, you probably have either a premature ventricular contraction, detect some sort of ventricular or junctional problem. Okay? Um, if you have any kind of sinus rhythm, your QRS should be normal. So these things, regular 60 to a hundred beats a minute. One-To-One PQRS ratio, a PR interval of less than 0.2 seconds and a PR or a QRS complex of less than 0.12, that's all normal.
And that is what would get us a normal sinus rhythm. Sinus meaning an initiator and assignment sinoatrial node, the essay node. So your last, your sixth step is always interpret what the heck, what the heck are you looking at? Right? So it's really five steps to interpretation, but step six is actually figuring out what the problem is, right? So the easiest way to memorize or understand, um, different EKG is and how to interpret is just to figure out what's abnormal. Okay? So if you know what's abnormal about that rhythm and you know what the standard mammal is, then you don't need to memorize, okay? So for Sinus Tachycardia, it's, it's regular and its PR interval is this and it's cute. [inaudible] you need to know is it's normal except it's normal except so sinus tachycardia and Sinus Bradycardia. The only two things you're going to see different is the rate sinus Tachycardia is too fast.
Sinus Bradycardia is too slow. That's it. Everything else should be normal. Everything else should be normal. You should have a one to one, you should be regular. You should have less than 0.2 seconds on the PR. You should have less than 0.1, two seconds on the QRS. It's just the rate. It's either too fast or too slow. That's it. K sinus tax, Sinus, Brady. So those three are your easiest ones. Know what normal is? Size, taxi, facetime sprays too. Too slow. Okay. Now let me show you three rhythms that you should be able to identify every time without ever touching those six steps ever. Okay? And I'm going to quiz you. So as soon as I hold it up, you tell me what you think it is. Okay? What's this one? B. Tack. Good. And curricular. Tack and Cardiac. You have wide. Complex QRS is you have a rate faster than a hundred beats a minute. Usually closer to 150. You have no p waves. You have nothing else going on. It's just boom, boom, boom, boom, boom. Okay. And Tricolor tack a cardiac. I'm showing you these because I think the most important thing that you guys understand is how to recognize rhythms that you must intervene on. Okay? Um, so what about this one?
What about this one? What does that look like? Austin, you're funny.
[inaudible] ventricular fibrillation. Okay. Those ventricles are just going, they're not doing anything. Is it possible that the p waves are trying up under that? Yeah, and we just can't see it. That's very possible. But really the ventricles are just quivering. They're not doing anything coordinated. Here's the thing to know between V-fib and B PTAC, which one can have a pulse? Which one can have a pulse between V-FIB and B Tech? You guys now be taxed so often said, Shockey Shockey time for Vtech only if your patient doesn't have a pulse. Right? Otherwise we need to do something different. Right? So you can have the tack with a pulse. You will never have v-fib with a pulse. If you see the Fem ventricular fibrillation on your monitor, you need to run to your patient's room. Because if it is truly the Fed, they don't have a pulse. Their heart is not pumping.
They need to call a code blue. Okay? No. Is it possible that what you're seeing is artifacts and you need to go check the patient? Maybe they're totally fine. You just need to fix your leads. Sure, of course. But you should never assume that you have to go check on your patient because the chances of having a pulse are horrible. I'm seeing with me tack the tack with a pulse are very, very, very rash. Um, but I did have a patient in the TAC, the Poles for like four plus hours one day. So I, you know, it happens. Last one. You must be able to recognize from further away and girl, intervene. Do something for this poor patient. What would that be?
Yes. A systally, a sisterly Sinus, nothing. Austin Simon. Then now here's the difference. So some people will say, Oh, maybe the leads are just off. Maybe the leads are just off. Let me show you what it looks like when your leads are off. I'm just going to draw another color line right below this. Okay. If your leads are truly off, it looks like that it is straight across. Absolutely. Straight across because there's no, there's nothing happening. There's nothing to pick up because the leads are off, right? Absolutely straight. Perfectly horizontal means your leads are off. Is it possible to see a system like that? Yes, but it's most of the time the, the leads are picking up muscle and other things, electrolytes and things that are happening in the body. Right? So perfectly straight across means your leads are probably off a little bit of wiggle means your patients dead. Please go help them. Right? So those are the three I want you guys to be able to see from across the room. The other two I want you to be able to differentiate between, and I'm going to draw them really fast for you, um, is atrial fibrillation and atrial flutter. So I'm gonna draw the line down the middle and I draw both
[inaudible]
okay. Okay. So one of these is atrial fibrillation and one of these is atrial flutter. Which one is this?
Okay,
which one is this? A fib. So this one is a flutter atrial flutter. So can you guys see this like saw tooth zig-zaggy baseline, right? That zig-zaggy baseline versus this one. That's kind of more of a wavy baseline. That's your difference. It's going to be irregular. You're not going to have clear p waves or you're going to see this and think, why do I have a budget, Ian p waves, right?
It's going to be irregular. Your Qis is probably normal. Your rate could be normal, could be fast, just depends on the patient because it's irregular, right? So we just never really know. But these two things, the wavy baseline and the sawtooths baseline are your classic signs with an irregular rhythm of your atrial issues, atrial fib and atrial flutter. So again, if you can remember these classic signs, if you can remember the one thing that's abnormal, it's really easier to pick up on it, right? Okay. Loves heart blocks. Okay. I didn't think so. I didn't think so. All right, let's talk heart blocks really fast. There are 400 bucks to that. You need to know. Two of them are super, super easy to remember. The other two we have to differentiate and I'm gonna help you with that. Bear is first degree, second degree type one, second degree type two and third degree.
Okay. Third degree heart block is also known as complete heart block. Okay? So we also have seen these called 80 blocks, right? So remember the essay node initiates, the contraction goes through or initiates the electricity, goes through the Atria, it goes to the Ab node, the Ab node goes, hold on a second with the ventricle spill. Okay, now let's go. And then it sends a signal to the vegetables. So anytime we're looking at a block, we're looking at issues in communication between the essay known and the Ab node. Okay. If I have a complete heart block, third degree, complete heart block, is there any communication happening between the essay node and the Ab node negative? Nope. Nothing. Okay. So the essay node initiator gets the ventricles going, or sorry, the Atria, s a node, Atria, I say no. Gets the Atri going 60 to a hundred beats a minute. And the 80 nodes going, hello, why is nobody communicating with me?
Hello?
Right? Nothing. So the Atria are going to go, well, I've got to do this on my own. Then I gotta do something myself because there's no communication happening. So the AB node will start on its own initiating a ventricular contraction somewhere between 40 and 60 beats per minute. So I've got atria over here at 60 to a hundred and I've got ventricles, I can't even do it. I'm not that coordinated, right? So I've got atria going at 60 to 100 beats per minute. I've got ventricles going at 40 to 60 beats per minute and they are completely not talking to each other. So what you're going to see if you guys can see this, I'm gonna try to hold it real still for you.
Where's my pen? You've got p wave, the wave p wave p wave p wave. Completely random, right? Is there a p wave before every QRS? Nope. In fact there's like a random one here and a random one here. But look, the P are regular. They march out, they're consistently beating. This is probably about an 80 beats per minute. I don't have a stick. Second show was five about 80 beats per minute. Boom, boom, boom, boom, boom. Your ventricles, however, are like, ah, let me, I gotta do something cause nobody's communicating with me. So you can see these are much, much slower, probably 40 to 50 beats per minute, but it's completely not communicating. So your ventricles will be regular, your atrium will be regular, but they will be completely on their own. No communication. There's not a few way before every QRS. They're completely disconnected.
Okay. Complete heart block makes sense. Easiest one to to remember in that sense. That's complete. The other one to remember is a first degree heart block. Remember me telling you that? If you can just remember the one thing that's abnormal. I've had a rhythm, then you can remember it. There's one thing abnormal in a first degree heart block and it's this in a first degree heart block, your PR interval is greater than 0.2. That's basically the communication between the essay note and the Ab node is slower than it should be. It's still happening, so you still have one to one. Your QRS is are still good. Your rates might be a little slow just because it's taking a little bit more time, but everything else is normal except this. It's just taken a little bit of extra time to get from the essay node to the Ab node. That's it. First degree heart block. Makes Sense. Happy with first and third questions about first and third.
Awesome. Okay, let's talk second. You have second degree type one and second degree type two. So I'm gonna tell you a little story. Second degree type one also called mobe. It's one also called [inaudible], some tiny little story about old man Wiki mark. And I'll be quick because I know we're already running out of time. So Oldman winky back. He's sitting in his recliner and the phone rings and he's like, Oh God. I answered the phone. He gets up, he goes over, he answers the phone at the telemarketer. He's like, Hey, Zach goes back to his chair, sits down phone rings again. He's like, so he gets up and he walks over a little bit slower, takes a little bit more time, gets to the phone, picks up the phone. I had to tell a marketer and he's like, really walks back to his chair and now he's getting tired.
Phone rings again. He's like, are you kidding me? He gets up and he shuffles over. He gets to the phone, picks it up and it's telemarketer. So he hangs it up. You slowly gets himself back to his chair. Next set of phone rings. He's like, [inaudible] not even going to answer it. I'm not even gonna pick it up. Nope. Not going to answer. Let to go to voicemail. He rests, he relaxes. He gets his energy back. Phone rings again. And he's like, okay. So we had a time. That was this long time. That was this long time. That was this long. And then he quit and then he got his energy back. So at times this song, this song, this song quit. Okay, so the other little phrase you can use, I like old name like you bought, cause it makes me laugh. You're, the phrase you can use is longer, longer, longer drop.
Now you have a winky box. I've also heard people talk about winky, winky, winky, buck longer, longer, longer drop. When can we, can we keep up longer, longer, longer job. So your PR interval, that's what we were looking at. Getting longer. You notice right here, this one, we've got about six small boxes from the beginning of the p to the beginning of the QRS here. This one we've got, oh my goodness. Probably about nine. And then we just drop. We're like, forget it. I'm not even gonna pick up the phone. It's probably a telemarketer. I don't even care. And so we drop a QRS entirely. There's a p wave and there is no QRS. The next time you see a QRS, you're back to that about point there about six small boxes. Now you're back to that like nine or 10 small boxes and then you drop again.
Okay. Longer that PR interval longer, longer, longer drop. Okay. It is possible that it's longer, longer, longer, longer, longer drop. Just depends on the patient, right? It's also possible that it's longer, longer drop. Um, but it's that growing PR interval that tells you that you have a type one or winky box. You can remember old man winky box and you can remember longer, longer, longer job, whatever works for you. But it's that growing PR interval that makes it a type one. Okay. For a type two for a type two why I always say is type two drop to Q type two Dr Q where you can say draft to cube. That's type two. Whatever works for you. So your PR interval is consistent. It doesn't change. It's, it might be a little bit long, but it doesn't change. It's consistent, but you just miscellaneously start losing Q waves.
Okay. So you're going to have more peas than QRS is because you're going to go normal, normal p wave drop, normal, normal, normal p wave drop. Okay, so I'm just dropping cubes. Drop the queue. That's type two if possible that you could have a two to one second degree heart block. What that means is that you, every other beat drops a cue, in which case you can't really tell if it's type one or type two because you can't see if the PR interval was getting longer and longer. So they call it a two to one but either way, if you're dropping Q it's going to be taped him. So Tom, is it always in sets of three or two or can it be an irregular patterns? Absolutely. It can be irregular. It's not always consistent. Patients don't read the textbook, which is so frustrating. Right. Um, so yes, absolutely. It can be irregular. It can be two beats and then drop. It can be seven beats and then drop. They can go a full minute and a half and then drop. But if they're dropping cues without that prolonging PR interval, then it's a type two. Does that makes sense? But yes, absolutely it can be. It's not always consistent.
Yeah.
I wish patients would read textbooks since you make life easier.
Alright. That helps for heart blocks. I'm going to drop a couple of weeks while you guys are asking questions. If you have questions, let me know. Um, but I'm a drop a couple of links. Make it part of the hospital's charge. Yeah. If you don't read the textbook, you get charged extra. Right? Um, so first one is we have a cheat sheet for heart blocks. They give you like, uh, descriptions of how to figure out heart blocks. Um, I'm going to give you a library search for the word rhythm and for the word EKG. And so what that does is it will give you basically all of the EKG t sheets that we have. Um, on the 10 most common rhythms. There's a whole EKG chart with the characteristics of every possible read in that you're gonna see, um, there's 10 most common things like that. So
yes.
Oh, um, I guess I did actually have to get it. So not only are we going to tell you how to figure out the rhythm, we're actually gonna tell you what to do about it too, which is really exciting. So we're gonna really, really awesome. Oh, sorry guys, can y'all still hear me? Awesome.
Yeah.
Okay. So Austin asked for the [inaudible], but we need to know what ventricular hypertrophy looks like on an EKG as well. Or is that more advanced? That attends to be more advanced? You tend to only be able to see that on a 12 lead EKG cause you're looking at access deviation and you're looking at, you know, with an amplitude and things like that. Um, so that tends to be more advanced, can see more. It's more like a 12, 12 lead type interpretation. Good question.
Okay.
But remember, bigger right ventricle, ventricular hypertrophy, bigger ventricles, more space for the electricity around. Right? So you're gonna see a bigger complex, either taller or wider or both, but you probably won't see that on the on clicks. What are questions? Can I answer for you guys? I know we went a little bit over. I apologize.
Oops.
Awesome. All right guys. So, so the only thing I've 12 leads on the end quacks is going to be things like understanding, uh, how to recognize a stemi. Um, but there's not going to be the specific detailed information about 12 leads on, on the, on Cox because that's not an entry level nurse. Um, skill.
Okay.
If any of you get to the NCLEX and have a laugh, have a question that's very specific on how to read a 12 lead, please let me know. But it is not a, it's not an entry level nurse skill. It's more advanced. Awesome. Hi Guys, I'm gonna drop that survey form. Please fill that out. Let us know. I know right at the beginning someone asked for more electrolyte lessons, so please let us know. What kind of lessons do you want to see times of day that work for you? What's working, what's not working, all of that. Um, so that we can make these experiences awesome for you guys. Cool. All right, well, if there's not any other questions, then ya'll go out and be your best selves today. And as always, happy nursing.