Communicating and Documenting EKG Findings
Key points on writing a structured EKG interpretation, comparing priors, and escalating urgent findings.
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Questions Covered in This Set
10 cards to master
What are the 8 elements of the standard EKG interpretation format, in order?
1) Rate, 2) Rhythm, 3) Axis, 4) Intervals (PR, QRS, QT/QTc), 5) Chamber abnormalities/hypertrophy, 6) ST/T changes and Q waves, 7) Comparison to prior, 8) Overall impression/clinical correlation.
What is the difference between descriptive, interpretive, and recommendation language?
Descriptive states what the tracing shows ('2 mm ST elevation in II, III, aVF'); interpretive states what it means ('consistent with acute inferior STEMI'); recommendation states the action ('activate cath lab, obtain V4R').
Why is comparison with a prior EKG often the highest-yield step?
Because the same finding means different things depending on whether it is new: 1 mm ST elevation unchanged for six years is benign early repolarization, while new 1 mm elevation may signal an occluded artery.
In what order should you scan when comparing to a prior tracing?
Rhythm, QRS morphology (new bundle branch block?), Q waves (new infarct?), ST segments, T waves, QTc.
Why should you document 'No prior available for comparison'?
It tells the next clinician why you are being cautious — the absence of a baseline is itself clinically useful information.
Why should you never copy-forward the machine's automated read unverified?
Computer algorithms miss subtle STEMI, over-call atrial fibrillation in artifact, and mislabel paced rhythms. If you accept it, you own it — write 'machine read confirmed' or state your own read.
Which findings require immediate verbal escalation ('tap someone on the shoulder now')?
STEMI or STEMI-equivalents (De Winter, Wellens, hyperacute T waves, new LBBB with Sgarbossa), VT/VF/torsades, complete heart block or Mobitz II, symptomatic bradycardia <40, hyperkalemia patterns, QTc >500 ms, and new pre-excited atrial fibrillation.
How should suspected artifact be documented?
Name it and state what you did about it, e.g. 'Baseline wander in limb leads; tracing repeated with improved electrode contact — repeat shown here.'
What makes an impression 'actionable'?
It commits to numbers, names lead groups, states the change from prior, and ends with a recommendation (e.g., 'recommend troponin and clinical correlation') rather than vague hedging.
Give an example of weak documentation language to avoid.
'Possible abnormality,' 'borderline,' 'nonspecific changes, cannot rule out anything,' or 'artifact vs. real' with no follow-up plan.
