© zphoto/Shutterstock; Left: © Steve Cole/Photodisc/Getty Images; Right: © Hemera/Thinkstock
© zphoto/Shutterstock; Left: © Steve Cole/Photodisc/Getty Images; Right: © Hemera/Thinkstock
The interpretation of arrhythmias and ECGs is an art form more than it is a science. These final tests are intended to bring these concepts out by challenging you and making you use all of your reasoning powers and newfound knowledge. Don’t worry if you don’t get every strip correct. In order for this test to be challenging, some strips have to push you to the limit. Many times, the strip will only allow you to narrow the differential down to just a few possibilities. This is the way that it should be, because this emulates real situations. Narrowing the possibilities down to a final one usually requires clinical correlation with your patient, evaluating a full 12-lead ECG, or comparison to old strips. Right now, concentrate on the process rather than on scoring 100% correct.
When you are faced with a tough strip, take some time, take a deep breath, and above all don’t panic. Begin to analyze the rhythm slowly and methodically, just as we taught you in Chapter 40, Putting It All Together. You will see that every bit of uncovered information will narrow your list of differentials down a little bit further. Eventually, the answer will become clear.
We are making an effort to cover most of the arrhythmias we have seen in this text. We have, however, weighted the test to reflect the most frequently clinically observed arrhythmias. We have also used some strips to reinforce some of the main take-home messages that we have presented in the individual chapters. When you are done, turn to the answers and analyze the way that we approached the strip. It may not be the same way that you did, but that’s OK. There are many paths to the same answer. The object is to examine the thought process involved; you can adjust it to fit your personal pattern as you progress. If you find that you are missing any particular arrhythmia with any frequency, spend a few minutes and go back and review that section again. Practice makes perfect in arrhythmia recognition.
When you have reviewed the material and you feel comfortable with your skills, put the text away for a while. In a couple of months, pick it up again and retake the tests. (Trust me, you won’t remember most of the answers.) This will reinforce the knowledge that you have gained and solidify your clinical skills at arrhythmia recognition. In your clinical practice, read as many strips as you can every day. Over time, you will notice how proficient you have become and you will develop the confidence needed to confront any situation. That said, remember the old adage “know your limitations.” When you find a strip you are not sure about, don’t ever be afraid to ask for help.