There are multiple websites that aim to teach students about electrocardiograms (ECG/EKGs). One website that was quite effective is the one build by a paramedic, Aaron Segal (n.d.). One positive attribute of this site was the use of analogies and humor. Although the toilet analogy for the description of absolute and relative refractory period might be considered by some to be in poor taste, it is certainly easy to remember (Segal, n.d., Cardiac contraction and ECG). From this site I learned basic information about ECGs including how to read a normal one, the steps of interpreting an ECG, and some examples of the abnormalities that could be present.
A second website on this topic was the Skillstat Six Second ECG site (2013). This simulator site is extremely useful in providing practice in reading a wide variety of ECGs almost as they occur in real patients. Further, there was a built in game that allowed you to test your knowledge. If the game did not go smoothly, it made sense to go back and review the examples again until the various examples could be easily distinguished from each other. This was a useful and fun way to gain abilities in being able to distinguish one abnormal read-out from another.
Because of the positive experience on the Skillstat simulator, the next website reviewed was the Skillstat learning area. This site provided a learning experience on Advanced Cardiac Life Support (ACLS) and a trivia challenge on cardiac topics (Skillstat, 2013). Both of the Skillstat learning areas were useful as tests, but it makes sense to learn the material first, and then use the sites. Although the tests did provide explanations that were useful if an answer was not understood it would not be an effective way to learn the material for the first time. The primary thing I learned was to continue studying in the ACLS and cardiac areas to help improve my scores.
The final website visited was one built by Dr. R. Richter (2005). The strength of this site was the extensive use of medical terminal and definitions. If someone were a non-visual learner, this site would work for him or her. However, for learning about reading an ECG/EKG, this site was very difficult to use because it included only two examples of actual strips and they were both abnormal. It would have been helpful to have examples of both normal and abnormal readouts for comparison. From this site I learned additional terminology and syndromes not discussed in other sites like Paroxysmal Atrial Tachycardia (PAT) and Pre-Excitation Syndromes.
Four different kinds of shock include hypovolemic, cardiogenic, anaphylaxic, and septic. Hypovolemic shock results from inadequate volume of fluid for the amount of intravascular space (Urden, Stacy, & Lough, 2013, p. 891). Some nursing interventions include minimizing fluid loss, administering fluids to replace those that are loss, and providing comfort and emotional support. Some steps that help reduce fluid loss are limiting blood sampling, watching intravenous lines for accidental disconnection, and reducing bleeding through direct pressure. Urden, Stacy, & Lough state that replacing fluids can helped by using large bore needles, giving fluids right when ordered, and elevating the legs and head and chest of the patient during administration (2013, p. 891).
The next kind of shock is cardiogenic shock. Cardiogenic shock results from the heart being unable to pump the blood (Urden, Stacy, & Lough, 2013, p. 894). Some nursing interventions include administering oxygen to keep it going to the tissues, administering a diuretic such as mannitol to keep renal blood flow and urine output adequate, and allow rest periods from oxygen therapy when possible to reduce stress (Urden, Stacy, Lough, 2013, p. 895). Urden, Stacy, & Lough suggest while monitoring if the patient’s skin becomes cold and clammy and if the patient’s temperature is dropping, there is the danger of progressive shock which is when damage can become more severe and can be irreversible (2013, p. 895).
A third kind of shock is anaphylaxic shock. This shock results from hypersensitivity reactions (Anaphylaxis in adults, 2002). Nursing interventions include administering oxygen therapy, administering epinephrine (which can be tried again after no improvement in five minutes), and if there is still no improvement, calling for hospital emergency transport if that is not the current location of the patient (Anaphylaxis in adults, 2002). After this experience, it is advisable for patients to carry their own self-administered epinephrine syringes.
A final kind of shock is septic shock. Septic shock is caused by of spreading of an infection from the initial site into the bloodstream, and the resulting severe inflammatory response syndrome (SIRS) (Mann, n.d.). Some nursing interventions for this type of shock include antimicrobials, fluid resuscitation, and oxygenation. Antibiotic therapy improves the odds of survival. Vasopressors may be administered if the fluid resuscitation is not effective to restore adequate perfusion. Mann notes that in extreme cases, dialysis may be necessary (n.d.). As implied by the use of the term “shock,” each of these situations require quick thinking, evaluation, and action for the nurse who plays a key part in restoring the health of the patient.
References
Anaphylaxis in adults (2002). Nursing Times. [online]. 1 October. Retrieved from http://www.nursingtimes.net/anaphylaxis-in-adults/199641.article
Mann, A. (n.d.). Septic Shock. Advance for Nurses. [online]. Retrieved from http://nursing.advanceweb.com/continuing-education/ce-articles/septic-shock.aspx
Richter, R. (2005). Basic Electrocardiography. Retrieved from http://www.sh.lsuhsc.edu/fammed/OutpatientManual/BasicECG.htm
Siegal, A. (n.d.). Electrocardiography. Retrieved from http://www.drsegal.com/medstud/ecg/Electric.htm
Skillset. (2013). The six second ECG. Retrieved from http://www.skillstat.com/tools/ecg-simulator#/-home
Skillset (2012). Challenge your cardiovascular knowledge and skills. Retrieved from http://www.skillstat.com/tools/
Urden, L., Stacy, K. & Lough, M. (2013). Critical care nursing. St. Louis, MO:Elsevier
