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1. Review normal 12-Lead EKG and the polarity of each lead
2. Identify axis deviation and implication in clinical practice
3. Discuss the criteria, causes, and significance of left and right bundle branch blocks
4. Analyze EKG changes associated with ischemia, injury, and infarction patterns
5. Develop a quick approach to diagnosis of STEMI on 12-lead EKG
6. Analyze EKGs for subtle and high-risk signs
7. Develop a systematic approach to chest X-ray interpretation
8. Identify correct placement of common invasive lines on chest X-rays
9. Differentiate between common cardiac and pulmonary disorders on chest X-rays
10. Discover the clinical pearls of EKG and chest X-rays in challenging case studies

PART I: THE ABCS OF 12-LEAD EKG INTERPRETATION

12-Lead EKG 101

• Cardiac electrical conduction system
• Electrical vectors
  • Introduction to the 12-leads
    • Limb leads
    • Augmented leads
    • Chest leads
• Normal polarity and P-QRS-T configuration of each lead

Ace the Axis

• Left and right axis deviation
• Causes and criteria of axis deviation
• Methods to determine axis deviation
• Case presentations, analysis, and clinical application

Beat the Bundles

• Right and left bundle branch blocks (BBB)
• Criteria for right vs. left BBB
• Causes and complications of right and left BBB
• Left anterior and left posterior hemiblocks
• Case presentations, analysis, and clinical application

Correlate the Coronary Anatomy

• Coronary arteries
  • Right coronary artery (RCA)
  • Left coronary artery (LCA)
  • Left anterior descending artery (LAD)
  • Circumflex artery (CX)
  • Posterior descending artery (PDA)
• Left ventricular walls
  • Inferior
  • Anterior
  • Septal
  • Lateral
  • Posterior
• Relationship of coronary arteries and ventricular walls to the 12-leads
  • Inferior—RCA—leads II, III, AVF
  • Anterior/septal—LAD—leads V1–V4
  • Lateral—circumflex—leads I, AVL, V5, V6
  • Posterior—PDA—reciprocal changes V1–V4

Differential Diagnosis: 12-Lead EKG in Acute Coronary Syndrome

• Ischemia pattern
• Injury pattern
• Infarction pattern
• Reciprocal changes
• ST segment elevation myocardial infarction (STEMI)
• Non-ST segment elevation myocardial infarction (NSTEMI)
• Coronary spasm
• Takotsubo cardiomyopathy (broken heart syndrome)

Example and analysis time - Piecing it all together

• 30-second diagnosis of STEMI on 12-lead EKG
• Coronary angiographic correlation to 12-lead EKG
• Case presentations, analysis, and clinical application

Advanced 12-Lead: Challenging Clinical Presentations

• Atrial and ventricular hypertrophy
• Wolff-Parkinson-White syndrome
• Prolonged QT intervals

PART II: CHEST X-RAY INTERPRETATION - AS EASY AS BLACK AND WHITE
Note: Most chest X-ray examples will be AP films

Chest X-ray basics

• Technique
• Black and white principles
• Projections
  • Anterior-posterior (AP)
  • Posterior-anterior (PA)
  • Lateral

Systematic Approach

• Bone structures
• Intercostal spaces
• Soft tissues
• Lungs/trachea/pulmonary vasculature
• Pleural surfaces
• Diaphragm
• Mediastinum
• Heart and great vessels
• Invasive lines

As Easy as Black

• Pneumothorax
• Subcutaneous emphysema
• Clinical application and treatment

As Easy as White

• Pleural effusion
• Pulmonary edema
• Pneumonia
• Atelectasis
• Acute respiratory distress syndrome (ARDS)
• Cardiomyopathy
• Pericardial effusion
• Cardiac tamponade
• Clinical application and treatment

Beyond the Basics

• Aortic aneurysm
• Post-op changes with pneumonectomy
• Hydropneumothorax
• Esophagogastrectomy
• Dextrocardia
• Clinical application and treatment

PART III: CXR & 12 LEAD EKG CASE PRESENTATIONS, ANALYSIS, AND CLINICAL APPLICATION

Cheryl Herrmann, RN, MS, APRN, CCRN, CNS-CSC/CMC, has 35+ years of nursing experience-15 years as a bedside nurse in SICU, Neuro ICU, and CVICU, and 20 years as a cardiac clinical nurse specialist. As a cardiac SNS, she cares for patients in cardiac prep and recovery, cardiac catheterization, surgery, ICU, telemetry/progressive unites, and at discharge. In addition, Cheryl is a prehospital RN for the local ambulance service. She has a passion for cardiac nursing and is an advocate for heart health.

Cheryl is a reviewer for a critical care textbook as well as several nursing journals, one of which, Critical Care Clinics, recently published her article "A Woman's Heart Is Different." She is a popular presenter for national conferences such as the American Association of Critical Care Nurses NTI. Cheryl has been honored with the American Association of Critical-Care Nurses Circle of Excellence--Excellent Clinical Nurse Specialist Award.

Speaker Disclosures:

Financial: Cheryl D. Herrmann has an employment relationship with UnityPoint Health Cardiology. She receives a speaking honorarium from PESI, Inc.

Non-financial: Cheryl D. Herrmann is a member of the Illinois Society of Advanced Practice Nurses and National Association of Clinical Nurse Specialists.

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Listed below are the continuing education credit(s) currently available for this non-interactive self-study package. Please note, your state licensing board dictates whether self study is an acceptable form of continuing education. Please refer to your state rules and regulations.

Certificates of Successful Completion are available for email, download and/or printing from your online account immediately following the successful completion of the post-test/evaluation.

**Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of mental health professionals. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your professions standards.

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners. For speaker disclosures, please see the faculty biography.

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Nurses/Nurse Practitioners/Clinical Nurse Specialists - Credit Expired: 6/2/2018
No CE available for this board.

California Nurses: PESI, Inc. is a provider approved by the California Board of Registered Nursing, Provider #:17118 for 5.0 self-study contact hours.

You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

Florida Nurses: PESI, Inc. is an approved provider by the Florida Board of Nursing. Provider #: FBN2858. These materials qualify for 5.0 self-study contact hours.

Iowa Nurses: PESI, Inc. is an approved provider by the Iowa Board of Nursing. Provider #: 346. Nurses successfully completing these self-study materials will earn 5.2 self-study contact hours.

Copies of the evaluation may be sent to the IBON. You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

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Other Professions
This self-study activity qualifies for 5.25 clock hours of instructional content as required by many national, state and local licensing boards and professional organizations. Retain your certificate of completion and contact your board or organization for specific filing requirements.

Disclaimer: **Information obtained in this course should be used within your scope of practice.
**It is your ethical responsibility to report accurate hours to your licensing board.
**All self-study participants must complete and pass (80% or better) a post-test and evaluation prior to receiving a certificate of completion. If you require a copy of the test/evaluation for CE purposes, please print at the time you take the test. Or you may call our customer service department and a copy of your test/evaluation will be emailed to you. Please allow 30-45 days.

• Acute Care and Family Nurse Practitioners
• Registered Nurses in:
  • Critical and Intensive Care
  • Acute Care
  • Cardiac Care
  • Emergency Department
  • Physician Offices, Physician Assistants
  • Clinical Nurse Specialists
  • Medical Assistants
  • Emergency Medical Technicians
  • Paramedics
  • Respiratory Therapists