Course: PANRE Review Course & 100 Hours Category 1 AAPA Credit
Price: Starting at $649.00 (varies by gift card add-on)
Access Duration: 12 months from purchase date
Deliverables: 100 Category 1 AAPA CME Credits, 1,000+ board-style practice questions, and comprehensive video review modules.
For clinicians managing patients at the bedside, few skills are as critical: or as frequently misunderstood: as electrocardiography. Whether you are a Physician Assistant preparing for your NCCPA PANRE or a seasoned Nurse Practitioner looking to sharpen your diagnostic accuracy, mastery of the 12-lead EKG is non-negotiable. This week, we are highlighting a definitive resource for any clinical practitioner: Comprehensive Guide to EKGs Rhythms, 12-Leads, and Clinical Patterns at the Bedside by Jeremy Boroff, PA-C.
This guide is designed to move beyond basic memorization and transition into advanced clinical practice. It serves as an ideal companion to our PANRE Review Course, providing the deep-dive technical knowledge needed to navigate the cardiology sections of the NCCPA exam and real-world emergencies.
Systematic Mastery Across Five Strategic Parts
The book is structured into five distinct sections, allowing readers to build a foundation before tackling high-stakes clinical scenarios.
Part I: Foundations
The first step in EKG interpretation is establishing a foolproof method. This section covers cardiac anatomy and physiology, culminating in a five-step systematic reading method: Rate, Rhythm, Axis, Intervals, and Morphology. By following this rigid structure, you ensure that subtle findings: such as a slightly prolonged QT interval or a hidden Delta wave: are never overlooked.
Part II: Rhythm Recognition
Bedside rhythms are presented in the order they are most likely encountered in clinical practice. This includes everything from basic sinus variants to lethal arrest rhythms. This section integrates directly with ACLS protocols, ensuring that your interpretation leads immediately to correct clinical action.
Part III: Intermediate Interpretation
Once the basics are mastered, the text moves into axis determination, chamber enlargement, and bundle branch blocks. A significant portion of this section is dedicated to the full spectrum of ischemia, injury, and infarction. It provides the diagnostic criteria needed to differentiate between benign early repolarization and the early stages of an ST-elevation myocardial infarction (STEMI).
Part IV: Advanced Interpretation
This section is essential for practitioners in emergency medicine or critical care. It focuses on high-risk patterns that are frequently missed on automated computer interpretations. Topics include:
- Wellens’ Syndrome: Identifying critical stenosis of the LAD.
- De Winter T waves: Recognition of a STEMI equivalent.
- Modified Sgarbossa Criteria: Diagnosing acute MI in the presence of a Left Bundle Branch Block (LBBB).
Part V: Specialized Topics
The final section explores EKG nuances in specific populations, including pediatrics and pregnancy, as well as the complexities of pacemaker rhythms. The guide concludes with 30 integrated practice cases designed to turn academic knowledge into a clinical reflex.
Key Features for the Clinical Practitioner
This guide is built for the bedside, offering several practical features that distinguish it from standard textbooks:
- Clinical Pearls & Pitfalls: Strategic boxes highlight common diagnostic traps and essential "pearls" learned from years of clinical practice.
- High-Fidelity Illustrations: Every rhythm strip and diagram is generated to mirror the real-world EKGs you see on the monitor or paper printout.
- Advanced Decision Algorithms: Includes the Brugada algorithm for wide-complex tachycardia and patterns for electrolyte imbalances and drug toxicities.
- Rapid Reference Appendices: Quick-access tables for normal values, coronary territory maps, and the life-saving "H’s and T’s" of cardiac arrest.
You can find the book on Amazon here: EKG Rhythms & 12 Leads.
Maximizing Your CME Budget
At CME Review Courses, we provide more than just educational content; we provide an efficient way to utilize your employer-provided CME funds. Our CME with Gift Card packages allow you to add an Amazon or Apple Gift Card ($100–$1500) to your purchase.
When you purchase the PANRE Review Course, you receive 100 hours of AAPA Category 1 credit. By adding an Amazon gift card to your CME package, you can acquire resources like this EKG guide or other clinical tools to further enrich your practice: all within your single CME purchase.
Clinical Assessment
Case Study: Acute Chest Pain
Your patient is a 62-year-old male presenting to the Emergency Department with 45 minutes of substernal chest pressure described as "heavy." He is diaphoretic. His history includes hypertension and hyperlipidemia.
Vitals:
- HR: 98 bpm
- BP: 152/94 mmHg
- SaO2: 96% on room air
- RR: 20 breaths/min
EKG Findings:
The EKG shows 2mm ST-elevation in leads V2, V3, and V4, with reciprocal ST-depression in leads II, III, and aVF.
Question:
Which coronary artery is the most likely site of the occlusion?
A. Right Coronary Artery (RCA)
B. Left Circumflex Artery (LCx)
C. Left Anterior Descending Artery (LAD)
D. Posterior Descending Artery (PDA)
Explanation:
The correct answer is C. Left Anterior Descending Artery (LAD).
The EKG findings of ST-elevation in leads V2-V4 indicate an acute injury pattern in the anterior wall of the heart. The LAD provides the primary blood supply to the anterior wall and the interventricular septum.
- Choice A (RCA) is incorrect; RCA occlusion typically presents with ST-elevation in the inferior leads (II, III, aVF).
- Choice B (LCx) is incorrect; LCx occlusion typically affects the lateral leads (I, aVL, V5, V6).
- Choice D (PDA) is incorrect; PDA occlusion generally results in inferior or posterior wall changes, not isolated anterior V2-V4 elevation.
Practice Question: Wide Complex Tachycardia
Your patient is a 55-year-old female with a history of heart failure (EF 30%) who presents with palpitations and lightheadedness. The monitor shows a regular, wide-complex tachycardia at a rate of 170 bpm. She is hemodynamically stable.
Question:
According to the Brugada criteria, which of the following features most strongly suggests Ventricular Tachycardia (VT) over Supraventricular Tachycardia (SVT) with aberrancy?
A. Presence of an RS complex in all precordial leads
B. Absence of an RS complex in all precordial leads (concordance)
C. An RS interval of less than 100ms
D. A 1:1 P-wave to QRS relationship
Explanation:
The correct answer is B. Absence of an RS complex in all precordial leads (concordance).
In the Brugada algorithm, the absence of an RS complex in all precordial leads (V1-V6) is highly specific for Ventricular Tachycardia. This is known as "concordance" (where all complexes are either entirely positive or entirely negative).
- Choice A is a normal finding and does not help differentiate VT.
- Choice C is incorrect; an RS interval greater than 100ms in any precordial lead suggests VT.
- Choice D is more characteristic of SVT or sinus tachycardia, as VT often demonstrates AV dissociation (more QRS complexes than P waves).
Conclusion
Mastering EKG interpretation is a lifelong pursuit for the dedicated medical professional. By combining the structured, clinical approach found in Jeremy Boroff's EKG Rhythms & 12 Leads with the comprehensive PANRE Review offered at CME Review Courses, you can ensure both exam success and clinical excellence.
Utilize your CME budget effectively this year. Choose a CME with Gift Card package to get your 100 hours of Category 1 AAPA credit and the tools you need for your medical library.