If you are looking for a book on the electrocardiogram (ECG), you are spoilt for choice—there are an abundance to choose from. The difficulty I have had is finding a book that is pitched at the right level for the paramedic. How much does a paramedic need to know about the ECG? As Douglas Chamberlain highlights in the foreword of this book, ‘everyone should have at least some knowledge of the heart’. From my experience, the more knowledge and understanding you have of ECGs, the better prepared you are to find the correct outcome for your patient. The issue is, how to learn what that squiggly line really means, how to partner this with your other clinical findings, and then come up with a working diagnosis and care plan. So, is this the book that will help you overcome your fear of ECGs?
The author begins with a useful guide to how to use the book; colour coding and four symbols provide clarity on the information provided and aim to highlight the important points which could protect your patient from harm. We are also directed to ‘The Golden Rule,’ which the reader should take special note of: ‘Always look at the patient’—I would suggest probably the most important message across the entirety of this book.
We jump straight in with section 1 and the fundamentals of cardiac function. The colour coding starts immediately and I find myself having to recap what the colour means. Then I find myself ignoring the colours and working my way through the information as it is all relevant. We are taken through the basics of the heart, circulatory system and electrical systems. The text progresses from the basics to more complex anatomy and physiology, including the dreaded sodium potassium pump. The information does help to build the foundations which will allow you to work your way through the 80 or so ECGs which follow, some of which are presented as full clinical case studies and some as overview examples.
The best way to learn any clinical assessment is to have a structured and systematic approach. The 9-step ECG interpretation tool is explained, which is useful, especially if you are relatively new to ECG interpretation. I am not sure however that we need two pages dedicated to four different methods of rate calculation as I have not come across an ECG in the prehospital setting that required it. The cardiac axis is explained well using some clear illustrations, which really help to understand this more complex element of the ECG.
As we work through section 2, we really start to delve into some very relevant topics for the prehospital clinician. We not only receive information relating to, for example, bradycardia; we are also provided with the clinical context including presentation of the patient, causes and management. The colour coding and symbols start to come into their own, providing clarity and easy navigation through what would otherwise be large blocks of text. The ECG examples are crystal clear and are provided for every rhythm. We are then able to test our knowledge with 10 practice ECGs and 5 full case scenarios.
The same format is followed as we move onto 12-lead ECG problems in section 3. There is a wealth of information presented and supported by full-page 12-lead ECGs. The clarity of the ECGs is better than you would expect from a standard printout you may be familiar with from the clinical setting; this really helps to identify the nuances of certain presentations. Again, some detailed case scenarios are provided for readers to work through, all supported by an impressive back of references. Finally, the appendices cover ECG electrode placement, paediatrics and human factors—though with only 8 pages dedicated to cover all these topics, it did leave me feeling a little short-changed. There were some obvious omissions around electrode placement on female patients. I understand that these can cause embarrassment; however, it is important for clinicians to have confidence when gaining the ECG and it is a question which often comes up in practice.
Nonetheless, all in all, the answer to my question posed at the beginning of this review is yes, this book really does make understanding the ECG manageable. It is clear, succinct and focuses on the need-to-know topics for the paramedic. The layout lends itself to be read from cover to cover, but also as a quick reference to recap on focused topics that may present in practice. I am pleased to share yet another quality ‘ambulance’-focused publication which should be on your book shelf.