First Step
The first step in your assessment should be to get a general sense of the
EKG. Mentally note if you see something out of the ordinary and come back
to it as you go through your assessment. Do all the leads look normal?
Is there normal R-wave progression? Is AVR inverted? Be very general in
this first assessment.
Second Step
The second step begins our formal analysis of the 12-lead EKG. Check the
calibration block on the 12-lead. Is it standard, half-standard, or 2
times standard? Don't forget to do this.
Third Step
The third step is to get the heart rate (ventricular and note the atrial rate).
Determine if the rhythm is regular or irregular in general. Count the rate using the
appropriate method for the rhythm (i.e., the 6 second method if the rhythm is irregular
and the R to R method for a precise heart rate).
Fourth Step
The fourth step is to specifically identify what rhythm is present on the
EKG. Generally, start with p waves. Are they present? Do they all look
the same? What is their rate? Are they regular? Most importantly, are
each p wave associated with a QRS complex on the EKG? What is the PR
interval? Next, look at the QRS. Is it narrow or wide? Ask yourself
again, do they occur at regular or irregular intervals? If irregular, is
the rhythm regularly irregular or irregularly irregular? This last step
should be the final clue as to what the rhythm is.
Fifth Step
The fifth step in our assessment is to determine what the mean QRS axis
is. First, determine if Leads I and AVF are mostly positive, mostly
negative, or biphasic to determine your quadrant. Next, find your most
biphasic limb lead. Now, determine what lead is perpendicular to
that biphasic lead and you have your axis vector. Remember to report the
axis and the degrees of the vector, in that order.
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