QRS Measuring

Basic EKG / ECG monitoring skills and certification, are now standard requirements in many hospitals and clinics. It certainly helps to have some prior exposure to the concepts, but in our class, it is not demanded as a prerequisite.

One of the most difficult skills to acquire, is the accurate measuring of the width of the QRS complex. We haven't been talking about the J-Point all this time, but now I have proposed that it become a part of our curriculum; this is currently under review.

Measuring Q

QRS measuring
It is tough to get it right,
Without proper instruction
Or low light at night,
One needs to understand the process
Of electrical action,
Dynamic to passive
To complete the transaction.

Does the monitor display
Just one line or six?
Are the QRS segments
Where they belong in the mix?
Because sometimes a Q-wave
Doesn’t show in the picture,
Or the R-wave went south
Like an esophageal stricture.

And what about that S-wave?
New students pass it over,
Measuring to the far side of the R
Like a hostile takeover,
Staking a claim
That the QRS is point-oh-four,
On an adult with heart disease
You need to double that score.

An important understanding
Regarding ionic flow,
Depolarizing is fast
And Repo is slow,
Thus, the QRS vectors
Show as quick straight lines,
Whereas repolarization
Has sloppier designs.

Is the ST-segment elevated
Or below the Iso-line?
Both will skew the measuring
So you must carefully assign,
The ending of the QRS
The crux of the problem at hand,
It is time to meet the J-Point
To fully understand.

The J-Point is found
At the S-wave end,
There is a shifting in direction
Like at a corner, then a bend,
It may be subtle or bold
The transition in the flux,
Study carefully the waves
Before you shoot your ducks.