This clinical mind map emphasizes addressing urgent/emergent situations which are listed under wide QRS complex tachycardia, and third-degree atrioventricular block under bradycardia. In addition, any situation in which the patient is unstable, as evidenced by abnormal vital signs and/or an appearance of distress, should be considered as an urgent/emergent situation.
Further organization is based upon whether the EKG shows bradycardia or tachycardia. The patient presentation for this clinical mind map is either feelings of palpitations which may be present in all differentials, or an abnormal EKG with or without symptoms. This clinical mind map addresses only abnormal rate and/or rhythm, and does not include differentials based upon EKG abnormalities representing ischemia, infarction, bundle branch blocks, axis abnormalities, chamber hypertrophy, or abnormal T and U waves. This exclusion of differentials is because patients with an abnormal rate or rhythm may present with palpitations, but patients with these abnormalities that are not included in this clinical mind map either present with symptoms addressed elsewhere in the book (chest pain for ischemia/infarction) or may not have any symptoms.
A mnemonic to remember the steps to reading an EKG is RRIPAQSO
R - Rate
Is Brady or Tachycardia present?
R - Rhythm
Is a P wave present? Is each P wave followed by a QRS?
I - Interval
Are PR, QRS, and QT intervals normal?
P - P Wave
Is the P wave normal morphology?
A - Axis
Is the axis normal, right or left?
Q - QRS
Is QRS normal or wide, is a Q wave present?
S - ST-T Segment
Is ST normal, elevated, or depressed?
O - Overall Interpretation
What is the overall diagnosis?
Often times, reviewing an EKG leads to the final diagnosis fairly quickly. However, an underlying pathology must be sought after to treat the root cause. A comprehensive work up including history, physical exam and lab data should help arrive at the final diagnosis.