Safety + Coordinated Care
32%of exam
HIPAAInfectionVitalsStress PrepAmbulatory Care
EKG Acquisition
44%of exam
EKG Analysis + Interpretation
24%of exam
Quick Facts
- Exam
- NHA CET
- Credential
- Certified EKG Technician
- Items
- 120 total
- Scored
- 100 items
- Pretest
- 20 items
- Time
- 2 hours
- Pass
- 390/500
- Heaviest
- EKG Acquisition
- Renewal
- 2 years
Stress Stop Signs
Pain, breath, dizzy, abnormal vitals.
Chest painDyspneaDizzinessAbnormal vitals
Holter vs Event
Holter
- Continuous recording
- Short wear period
Event
- Symptom-triggered recording
- Intermittent symptoms
Continuous vs triggered
Escalation Picker
- Chest pain occurs→Stop, notify provider
- Syncope occurs→Lower patient
- Severe dyspnea→Activate emergency plan
- Unstable VTach→Call emergency response
- VFib appears→Start BLS pathway
- Patient refuses→Document and notify
- PHI requested→Verify authorization
- Scope unclear→Ask supervisor
HIPAA + Scope
- PHI
- Identifiable health data
- Minimum necessary
- Limit disclosures
- Authorization
- Required for release
- Scope
- Perform trained tasks
- Interpretation
- Provider responsibility
- Documentation
- Objective facts only
- Ethics
- Patient-centered conduct
- Incident
- Report per policy
Stress vs Resting
Stress
- Exercise or medication
- Monitor adverse signs
Resting
- Supine baseline
- No exertion
Provoked vs baseline
Infection + Safety
- Standard precautions
- All patients
- Hand hygiene
- First defense
- Gloves
- Body-fluid barrier
- Disinfection
- Machine and leads
- OSHA
- Workplace safety
- Sharps
- Immediate container
- Exposure
- Wash and report
- Latex allergy
- Use latex-free supplies
Vitals + Emergencies
- Pulse
- Rate and rhythm
- Respirations
- Count unobtrusively
- BP
- Correct cuff size
- SpO2
- Oxygen saturation
- Chest pain
- Stop and notify
- Syncope
- Lower patient
- Dyspnea
- Breathing distress
- BLS
- Activate emergency response
Stress + Ambulatory
- Stress test
- Exertion monitoring
- Target HR
- Based on age
- 220-age
- Maximum HR estimate
- Adverse sign
- Chest pain, dizziness
- Holter
- Continuous recording
- Event monitor
- Symptom-triggered recording
- Diary
- Symptoms and activities
- Electrodes
- Keep attached
V Lead March
V1 right, V2 left, V4 fifth.
V1 RSBV2 LSBV4 MCLV6 midaxillary
Limb vs Chest Leads
Limb
- Arms and legs
- Frontal plane
Chest
- V1 through V6
- Horizontal plane
Plane matters
Acquisition Picker
- Routine diagnostic tracing→Standard 12-lead
- Continuous bedside monitoring→Telemetry
- Short symptom capture→Event monitor
- Daily rhythm capture→Holter monitor
- Exertion assessment→Stress test
- Suspected RV infarct→Right-sided leads
- Suspected posterior MI→Posterior leads
- Amputated limb→Proximal placement
Machine Setup
- Paper speed
- 25 mm/sec
- Gain
- 10 mm/mV
- Calibration mark
- 10 mm high
- Paper
- Load correctly
- Clips
- Replace if faulty
- Cables
- Untangled, intact
- Patient ID
- Verify before test
- Completed tracing
- All leads present
Somatic vs AC
Somatic
- Patient movement
- Muscle tremor
AC
- Electrical interference
- Equipment nearby
Body vs electricity
Artifact Picker
- Baseline wanders→Secure electrodes
- Muscle tremor→Warm patient
- Electrical noise→Move cords
- Lead drops out→Reconnect lead
- Poor adhesion→Clean, dry skin
- Respiratory drift→Relax breathing
- Limb reversal suspected→Check labels
- Artifact corrected→Repeat tracing
Skin Prep
- Explain test
- Reduce anxiety
- Supine
- Standard resting position
- Expose sites
- Maintain privacy
- Clean skin
- Remove oils
- Dry skin
- Improve adhesion
- Hair
- Clip if needed
- Lotion
- Remove before electrodes
- Stillness
- Minimize artifact
Lead Placement
- RA
- Right arm
- LA
- Left arm
- RL
- Right leg ground
- LL
- Left leg
- V1
- 4th ICS RSB
- V2
- 4th ICS LSB
- V3
- Between V2-V4
- V4
- 5th ICS MCL
- V5
- Anterior axillary line
- V6
- Midaxillary line
Special Leads
- Right-sided
- Suspected RV infarct
- V4R
- Right MCL mirror
- Posterior
- Suspected posterior MI
- V7
- Posterior axillary
- V8
- Midscapular line
- V9
- Paraspinal line
- Amputation
- Use proximal limb
- Pediatric
- Smaller electrodes
Artifact Fixes
- Somatic
- Muscle movement
- Wandering baseline
- Loose electrode
- AC interference
- Electrical noise
- Interrupted baseline
- Lead disconnect
- Dry electrodes
- Poor contact
- Tremor
- Warm and support
- Respiration drift
- Relax breathing
- Repeat tracing
- After correction
Rate Sequence
300, 150, 100, 75, 60, 50.
300150100756050
AFib vs Flutter
AFib
- Irregularly irregular
- No distinct P
Flutter
- Sawtooth waves
- Atrial flutter pattern
Chaos vs sawtooth
Rhythm Picker
- P before each QRS→Sinus family
- No P, irregular→Atrial fibrillation
- Sawtooth baseline→Atrial flutter
- Absent/inverted P→Junctional rhythm
- Early wide beat→PVC
- Wide fast run→VTach
- Chaotic tracing→VFib
- Flat tracing→Check leads first
Paper Math
- Small box
- 0.04 seconds
- Large box
- 0.20 seconds
- Five large
- 1 second
- Six seconds
- 30 large boxes
- Ten seconds
- 50 large boxes
- Vertical small
- 0.1 mV
- Vertical large
- 0.5 mV
- 10 mm
- 1 mV
Block Patterns
First long; Wenckebach longer; third divorced.
Long PRLonger-dropDropped QRSAV dissociation
VTach vs VFib
VTach
- Wide rapid rhythm
- May have pulse
VFib
- Chaotic rhythm
- No effective pulse
Organized vs chaotic
Waveforms + Intervals
- P wave
- Atrial depolarization
- PR interval
- AV conduction
- Normal PR
- 0.12-0.20 sec
- QRS
- Ventricular depolarization
- Normal QRS
- Under 0.12 sec
- ST segment
- Isoelectric segment
- T wave
- Ventricular repolarization
- QT interval
- Ventricular activity
Mobitz I vs II
Mobitz I
- PR lengthens
- Then QRS drops
Mobitz II
- PR constant
- QRS suddenly drops
Lengthens vs constant
Rate + Regularity
- Normal adult
- 60-100 bpm
- Bradycardia
- Under 60 bpm
- Tachycardia
- Over 100 bpm
- 1500 method
- Small boxes
- 300 method
- Large boxes
- 6-second method
- Complexes times ten
- Regular rhythm
- Consistent R-R
- Irregular rhythm
- Variable R-R
Rhythm Classes
- Sinus
- P before QRS
- Sinus arrhythmia
- Irregular sinus rhythm
- Atrial flutter
- Sawtooth flutter waves
- Atrial fibrillation
- Irregularly irregular
- Junctional
- Absent/inverted P
- PVC
- Early wide beat
- VTach
- Wide rapid rhythm
- VFib
- Chaotic ventricular rhythm
Blocks + Ischemia
- First-degree
- PR prolonged
- Mobitz I
- Longer, longer, drop
- Mobitz II
- Dropped QRS
- Third-degree
- AV dissociation
- Pacemaker
- Sharp spike
- Ischemia
- ST depression/T inversion
- Injury
- ST elevation
- Infarction
- Pathologic Q waves
Common Traps
CET Items
100 scored ≠ 20 pretest hidden
Heaviest Domain
Acquisition is 44% ≠ Protect placement points
EKG Interpretation
Recognize patterns ≠ Do not diagnose
Flatline Tracing
Check leads first ≠ Then escalate
Gloves
Not hand hygiene ≠ Wash still required
Artifact
Fix before reading ≠ Repeat after correction
Chest Lead Height
Count interspaces ≠ Avoid false changes
Stress Symptoms
Stop and report ≠ Do not continue
Last Minute
- 1.CET: 100 scored items
- 2.Acquisition domain: 44 items
- 3.Pass score: 390/500
- 4.Paper: 25 mm/sec
- 5.Gain: 10 mm/mV
- 6.V1 right fourth ICS
- 7.V4 fifth ICS MCL
- 8.PR normal: 0.12-0.20 sec
- 9.QRS normal: under 0.12 sec
- 10.AFib: irregularly irregular
- 11.Artifact first, rhythm second
- 12.Interpretation belongs to provider
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