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How to Read and Interpret an ECG - A Beginner's Complete Guide

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What is an ECG?

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Part 1 - The Electrical Story of One Heartbeat

1. SA node (sinoatrial node) - the heart's natural pacemaker, in the right atrium. Fires a spark.
2. Spark spreads across both atria → they contract (squeeze blood into ventricles).
3. Signal reaches the AV node (atrioventricular node) → it intentionally slows the signal to give ventricles time to fill.
4. Signal passes down the Bundle of His → splits into right and left bundle branches.
5. Branches spread into Purkinje fibers → ventricles depolarize and contract (the main pumping action).
6. Heart muscles repolarize (reset electrically) → ready for the next beat.

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Part 2 - The ECG Paper: How to Read the Grid

Each tiny square = 0.04 seconds (40 ms) wide, 1 mm tall
Each big square  = 0.20 seconds (200 ms) wide, 5 mm tall
Standard speed   = 25 mm per second
Standard height  = 1 mV = 10 mm (10 small squares)

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Part 3 - The Waves, Segments, and Intervals

The P Wave

• What it is: The first small rounded bump.
• What it means: Atrial depolarization - the atria are contracting.
• Normal: Upright (positive) in lead II, rounded, <0.12 s wide (3 small boxes), <2.5 mm tall.
• If abnormal: Missing P waves → think atrial fibrillation. Tall/wide P waves → atrial enlargement.

The PR Interval

• What it is: From the start of P to the start of QRS.
• What it means: Time for the signal to travel from atria through the AV node to the ventricles.
• Normal: 0.12 - 0.20 s (3 to 5 small boxes / up to 1 big box).
• If too long (>0.20 s): First-degree AV block (signal is delayed).
• If too short (<0.12 s): Pre-excitation (signal bypasses the AV node, as in Wolff-Parkinson-White).

The QRS Complex

• What it is: A tall, narrow, sharp spike - the most prominent feature on any ECG.
• What it means: Ventricular depolarization - both ventricles contracting and pumping blood.
• Parts:
  • Q wave - first downward deflection (if present)
  • R wave - first upward deflection
  • S wave - downward deflection after R
• Normal: <0.12 s wide (<3 small boxes), narrow and sharp.
• If wide (≥0.12 s): Bundle branch block, ventricular rhythm, or drug toxicity.
• Pathological Q waves (deep and wide): Old myocardial infarction.

The ST Segment

• What it is: The flat line between the end of QRS and the start of the T wave.
• What it means: Ventricular plateau phase - ventricles are still depolarized (between contraction and recovery).
• Normal: Should sit on the baseline (isoelectric) - neither elevated nor depressed.
• If elevated: STEMI (ST-elevation myocardial infarction) - a heart attack in progress. This is an emergency.
• If depressed: Ischemia (reduced blood flow to heart muscle) or certain drug effects.

The T Wave

• What it is: A broad, rounded bump after the QRS.
• What it means: Ventricular repolarization (the heart "resetting" electrically).
• Normal: Should be upright (same direction as QRS) in most leads, rounded, not too tall or too peaked.
• If inverted: Ischemia, bundle branch block, ventricular hypertrophy.
• If peaked/tall: Hyperkalemia (high potassium) - can be dangerous.

The QT Interval

• What it is: From the start of QRS to the end of T wave.
• What it means: Total time for ventricular depolarization + repolarization.
• Normal: Roughly <440 ms in men, <460 ms in women (varies with heart rate - always "correct" it with the QTc formula).
• If prolonged: Risk of dangerous arrhythmias (Torsades de pointes). Caused by drugs, electrolyte problems, or congenital syndromes.

The U Wave

• What it is: A small, optional bump after the T wave.
• What it means: Thought to represent repolarization of Purkinje fibers or papillary muscles.
• Normal: Present in some people, especially in leads V2-V3, same direction as T.
• If prominent: Hypokalemia (low potassium).

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Part 4 - The 12 Leads: What Are They?

• Leads I, II, III (standard limb leads)
• Leads aVR, aVL, aVF (augmented limb leads)

• V1, V2, V3, V4, V5, V6

• V1: Right sternal border, 4th intercostal space
• V2: Left sternal border, 4th intercostal space
• V3: Between V2 and V4
• V4: Midclavicular line, 5th intercostal space
• V5: Anterior axillary line, same level as V4
• V6: Midaxillary line, same level as V4 and V5

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Part 5 - The Systematic 7-Step Approach

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Step 1 - Check Rate

1 big box  → 300 bpm
2 big boxes → 150 bpm
3 big boxes → 100 bpm
4 big boxes → 75 bpm
5 big boxes → 60 bpm
6 big boxes → 50 bpm

• >100 bpm = Tachycardia
• <60 bpm = Bradycardia

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Step 2 - Check Rhythm

1. Are the R-R intervals regular or irregular? (Mark peaks on a piece of paper and compare)
2. Is there a P wave before every QRS? Is there a QRS after every P?

• No P waves + irregularly irregular → Atrial Fibrillation (AF)
• Sawtooth baseline + rapid rate → Atrial Flutter
• Wide complex + very fast → Ventricular Tachycardia (VT) - emergency
• No organised activity → Ventricular Fibrillation (VF) - cardiac arrest

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Step 3 - Check Axis

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Step 4 - Check Intervals

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Step 5 - Examine the P Wave

• Present before every QRS? → Normal sinus mechanism
• Absent? → AF, junctional rhythm, or SA node problem
• Tall and peaked (>2.5 mm in II)? → Right atrial enlargement
• Wide and notched (>0.12 s in II)? → Left atrial enlargement
• Inverted in II? → Ectopic atrial rhythm (signal not coming from SA node)

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Step 6 - Examine the ST Segment and T Waves

• In two or more consecutive leads → STEMI (acute MI) - call for help immediately
• Saddle-shaped, diffuse → Pericarditis
• Persistent with Q wave → Ventricular aneurysm

• Horizontal or downsloping → Ischemia (NSTEMI or unstable angina)
• Upsloping → Less specific, may be normal

• Symmetrically inverted in a territory → Ischemia or post-MI ("Wellens" pattern in V2-V3 is a warning of LAD stenosis)
• Peaked and tall → Hyperkalemia
• Flattened → Hypokalemia, ischemia

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Step 7 - Look for Special Patterns

• RBBB (Right Bundle Branch Block): Wide QRS + rSR' ("bunny ears") in V1 + wide S wave in V6. Memory: WiRRy - Wide QRS, R in Right leads (V1).
• LBBB (Left Bundle Branch Block): Wide QRS + broad notched R in I/aVL/V6 + QS in V1. Memory: WiLLiaM - W in V1, M in V6 for LBBB.

• LVH (Left Ventricular Hypertrophy): Tall R in V5 or V6 + deep S in V1 (sum >35 mm = Sokolow-Lyon criterion)
• RVH: Tall R in V1, right axis deviation

• 1st degree: PR >0.20 s, every P followed by QRS - benign
• 2nd degree Mobitz I (Wenckebach): PR gradually lengthens until a beat is dropped
• 2nd degree Mobitz II: PR constant, then a QRS suddenly drops - more serious
• 3rd degree (complete): P waves and QRS complexes march independently - emergency

• Hyperkalemia: Peaked T → widened QRS → sine wave pattern → VF
• Hypokalemia: Flat T + prominent U wave + prolonged QT
• Hypercalcemia: Short QT interval
• Hypocalcemia: Long QT interval

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Part 6 - Putting It All Together: A Worked Example

1. Rate: Count R-R big boxes → 4 boxes → 75 bpm. Normal.
2. Rhythm: R-R regular. P before every QRS. Looks like sinus rhythm.
3. Axis: Lead I upright, aVF upright → Normal axis.
4. Intervals: PR = 0.16 s ✓. QRS = 0.08 s ✓. QTc = 420 ms ✓.
5. P waves: Upright in II, smooth, <2.5 mm. ✓.
6. ST/T waves: 2 mm ST elevation in II, III, aVF + reciprocal ST depression in I and aVL → Inferior STEMI (right coronary artery territory). Call a code.
7. No bundle branch block or other special patterns noted.

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Part 7 - The 14-Point Checklist (Harrison's Framework)

1. Standardisation / calibration (is the 1 mV = 10 mm marker present?)
2. Technical quality (leads reversed? motion artifact?)
3. Rhythm
4. Heart rate
5. PR interval / AV conduction
6. QRS interval
7. QT / QTc interval
8. Mean QRS electrical axis
9. P waves
10. QRS voltages
11. Precordial R-wave progression (R waves should grow V1 → V6)
12. Abnormal Q waves
13. ST segments
14. T waves (and U waves)

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Quick Reference Card

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Tips for Beginners

• Always compare with a previous ECG - changes are often more important than absolute values.
• Treat the patient, not the ECG - a finding means nothing without clinical context.
• When in doubt, read it systematically - most errors come from skipping steps.
• Practice on real strips - free resources like ECG Wave-Maven (Harvard) let you practice hundreds of real cases.
• The most dangerous ECGs are the normal-looking ones - always do all 7 steps.

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• Color-coded header banner
• ECG waveform diagram (drawn programmatically) with P, Q, R, S, T, U labels and PR/QRS/QT interval arrows
• Waves & Intervals table - all 7 features (P wave, PR, QRS, ST, T, QTc, U) with what each represents, normal values, and what abnormalities suggest
• Heart Rate Calculator (big-box counting table + irregular method)
• Rhythm Quick-ID - 8 key rhythms from normal sinus to VF

• QRS Axis table (Leads I + aVF method, all 4 quadrants)
• ST Changes & Ischaemia - STEMI, pericarditis, NSTEMI, Wellens sign, posterior MI
• Bundle Branch Blocks - RBBB vs LBBB comparison with WiRRy/WiLLiaM mnemonics
• Electrolyte ECG Changes - hyper/hypokalaemia, calcium, magnesium, digoxin
• Lead Territories - inferior/anterior/lateral/posterior with culprit arteries
• 7-Step Systematic Approach strip - dark navy banner summarising the full method
• Source attribution footer

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Dobutamine Infusion Rate Calculation

Given Information

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Step 1 - Find the Stock Concentration in mcg/ml

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Step 2 - Calculate the Dose Required per Minute

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Step 3 - Convert to mcg per Hour

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Step 4 - Calculate the Infusion Rate in ml/hr

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Summary

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Clinical note: 0.18 ml/hr is an extremely low infusion rate that most standard syringe pumps can deliver, but always verify the pump's minimum delivery threshold (typically 0.1 ml/hr). If using a diluted solution (e.g. 250 mg in 250 ml = 1,000 mcg/ml), the rate would be 9 ml/hr - which is more practical for bedside administration. Always confirm with your institution's pharmacy protocol.

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Page 1 - Formulas & Conversions

• 8 Master Formulas in two color-coded columns (teal + dark blue): ml/hr from mcg/kg/min, mcg/min, mg/hr, units/hr, concentration, reverse-check, drop rate, and infusion time
• Unit Conversions table - double-sided: weight conversions (mg/mcg/g/ng) on one side, time and rate conversions on the other (mcg/min → hr, % solutions → mg/ml, etc.)
• Gravity Drip Rate lookup table - drop rates (drops/min) for 6 volumes (50-1000 ml) across 6 time periods, color-coded red (>60 drops/min, hard to count) and green (≤30 drops/min, easy)

Page 2 - Drug Reference Table (18 drugs)

• Vasopressors/Inotropes (red): Noradrenaline, Adrenaline, Dopamine, Dobutamine, Vasopressin
• Antiarrhythmics (purple): Amiodarone, Lignocaine
• Anticoagulants (orange): Unfractionated Heparin
• Sedation/Analgesia (teal): Morphine, Fentanyl, Midazolam, Propofol
• Vasodilators (blue): GTN, Labetalol
• Electrolytes/Others (green): KCl, Insulin, Magnesium Sulphate, Oxytocin

Page 3 - Worked Examples & Safety

• 3 side-by-side worked examples: weight-based (dobutamine), non-weight-based (GTN), and units/hr (heparin) - all with full step-by-step
• 8 Common Calculation Errors with explanations (KCl undiluted bolus highlighted as FATAL)
• Reverse-check formula banner for verifying any answer

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Best NCLEX Study Recommendations (2025-2026)

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First, Understand What NCLEX Tests

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1. Understand the NGN Format First

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2. Master the 4 Clinical Judgment Frameworks

A. Maslow's Hierarchy (for single-patient prioritization)

• Airway/Breathing/Circulation always beats pain, anxiety, or education

B. ABCs (Airway, Breathing, Circulation)

C. Assess Before Act

"The patient is anxious" → assess first "The patient is apneic" → act now

D. Maslow vs Safety Conflict

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3. The Right Study Plan Structure

Phase 1 - Content Foundation (Weeks 1-3)

1. Fundamentals - most tested across all categories
2. Pharmacology - medications appear in nearly every question
3. Med-Surg - cardiovascular, respiratory, neuro, renal
4. Mental Health - therapeutic communication, crisis, medications
5. OB/Maternal - fetal heart monitoring, postpartum complications
6. Pediatrics - growth/development, age-specific vitals

Phase 2 - Question Practice (Weeks 3-6)

• Do minimum 75-100 questions per day
• Target 70% accuracy before scheduling your exam
• Read every rationale - even for questions you got right. Understanding why matters more than the answer.

Phase 3 - Full CAT Simulations (Final 2 weeks)

• Do 2-3 full-length timed CAT (Computer Adaptive Test) simulations
• Identify your weak categories from analytics
• Final week: targeted review of weak areas only - do not re-study everything

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4. Best Study Resources (Ranked by Evidence & Community Consensus)

Question Banks (Most Important)

Video Resources

• Mark Klimek (free on YouTube) - legendary for pharmacology, prioritization, and acid-base. Must-watch.
• Dr Sharon NCLEX (YouTube) - 3 playlists: prioritization, fundamentals, and the "Bluebook." Highly recommended by the NCLEX community.
• Simple Nursing (Nurse Mike) - animated, easy to retain for visual learners

Books

• Saunders Comprehensive Review (Silvestri) - best single reference book, aligns to NCLEX client needs categories
• Prioritization, Delegation and Assignment (LaCharity) - best book specifically for NGN clinical judgment questions
• NCSBN NGN Quick Reference Guide - free PDF from the official source

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5. Test-Taking Strategies That Actually Work

The "Worst Consequence" Rule

The "Unexpected Finding" Rule

Eliminate First, Then Choose

• Cross out clearly wrong answers first (reduces to 2 options in most cases)
• Between 2 remaining: pick the one more specific to this patient, not general

SATA Strategy

• Better to get 2/4 correct than guess on all 4 and get 0

Delegation Rules (high-yield for NCLEX)

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6. High-Yield Content You Cannot Skip

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7. Critical Lab Values to Memorize

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8. Study Schedule Template (8-Week Plan)

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9. The Day Before & Exam Day

• Do not study the day before - light review at most. Your brain needs consolidation time.
• Sleep 7-8 hours - sleep is when memory consolidates.
• Eat a full breakfast with protein.
• Arrive early - know your testing center route in advance.
• During the exam: if a question feels impossible, use your frameworks (ABC, Maslow, safety) rather than guessing blindly.
• Don't count questions - the CAT stops anywhere from 85 to 145 questions for NCLEX-RN. More questions does not mean you are failing.

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10. Mindset: The One Thing That Separates Passers

"This is a safety exam. Think like a nurse, not a student."

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NCLEX Nursing Mnemonics - The Complete Master Reference

Over 100 mnemonics organized by category. Bookmark this page.

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CATEGORY 1 - NURSING PROCESS & CLINICAL FRAMEWORKS

ADPIE - The Nursing Process

Assessment → Diagnosis → Planning → Implementation → Evaluation

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ABCs - Physiological Priority Order

Airway → Breathing → Circulation

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MASLOW - Hierarchy for Prioritization

Meals (physiological) → Safety → Affection (love/belonging) → Looks (esteem) → Own potential (self-actualization) → Winning (reaching full potential)

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SBAR - Communication Framework

Situation → Background → Assessment → Recommendation

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SAMPLE - Patient History Taking

Signs & symptoms → Allergies → Medications → Past medical history → Last meal → Events leading to this visit

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OLDCARTS - Pain/Symptom Assessment

Onset → Location → Duration → Character → Aggravating factors → Relieving factors → Timing → Severity

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PQRST - Pain Assessment (Alternative)

Provocative/Palliative → Quality → Radiation → Severity → Timing

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PIE - Nursing Documentation

Problem → Intervention → Evaluation

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CATEGORY 2 - PRIORITIZATION & DELEGATION

CURE - What RNs Cannot Delegate

Complex assessments → Unstable patients → Reaching diagnoses → Education (initial)

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D-A-N-C-E - Delegation Rules

Do not delegate initial assessments Avoid delegating unstable patients No invasive procedures to CNAs Check the 5 rights of delegation Evaluate after delegating

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5 Rights of Delegation

Right task → Right circumstance → Right person → Right direction/communication → Right supervision

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CAN DO - What CNAs Can Do

Clean dressings (non-sterile, routine) → Ambulation (stable patients) → Normal vital signs (stable) → Dressing assistance (ADLs) → Oral hygiene, feeding (non-tube)

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CATEGORY 3 - PHARMACOLOGY

Drug Class Name Endings (Suffix Mnemonics)

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MONA - Acute MI Management

Morphine → Oxygen → Nitroglycerine → Aspirin

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LEAN - Emergency Medications

Lidocaine → Epinephrine → Atropine → Naloxone

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IDEA - Bradycardia Treatment

IV access → Drug (Atropine) → External pacing → Advanced interventions (permanent pacemaker)

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MADD DOG - Pulmonary Edema Treatment

Morphine → AminoPhylline → Diuretics → Digoxin → Oxygen → Gases (ABG monitoring)

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The 3 "Dig" Signs - Digoxin Toxicity

Digoxin toxicity = Diaphoresis, IGG (nausea/vomiting), Green-yellow halos in vision

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HIGH ALERT Medications - "PINCH"

Potassium chloride → Insulin → Narcotic opioids → Chemotherapy → Heparin

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Anticoagulant Antidotes

"Heparin Hates Protamine" - Heparin antidote = Protamine sulfate "Warfarin Wants Vitamin K" - Warfarin antidote = Vitamin K (+ FFP for urgent reversal) "Dabigatran Demands Idarucizumab" - Dabigatran antidote = Idarucizumab

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Insulin Types - "RIANT" Onset Order (Fastest to Slowest)

Rapid-acting (Lispro/Aspart) → Intermediate (NPH) → A... → N... → Time (Glargine = no peak)

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Lithium Toxicity - "FINE ARTS"

Facial twitching → Incoordination → Nausea/vomiting → Encephalopathy → Ataxia → Reflex changes → Tremors → Seizures

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Warfarin Food Interactions - "KALE"

Foods high in K-vitamin = Avoid consistency changes Leafy greens, Evening primrose are high in Vitamin K - avoid drastic changes

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CATEGORY 4 - ELECTROLYTES & FLUID BALANCE

PISO - Where Electrolytes Live

Potassium Inside → Sodium Outside (the cell)

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MURDER - Signs of HYPERkalemia (High K+)

Muscle weakness → Urine (oliguria/anuria) → Respiratory distress → Decreased cardiac contractility → ECG changes (peaked T waves → wide QRS → sine wave) → Reflexes decreased

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A SIC WALT - Signs of HYPOkalemia (Low K+)

Alkalosis → Skeletal muscle weakness → Ileus (decreased bowel sounds) → Constipation → Weak pulse → Arrhythmias → Lethargy → Thready pulse

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6 L's of HYPOkalemia

Lethargy → Leg cramps → Lax muscles (weakness) → Low, shallow respirations → Loss of bowel sounds → Lots of U-waves on ECG

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FRIED SALT - Signs of HYPERnatremia (High Na+)

Fever → Restlessness → Increased fluid retention → Edema → Decreased urination → Skin flushed → Agitation → Low-grade fever → Thirst (intense)

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SALT LOSS - Signs of HYPOnatremia (Low Na+)

Seizures → Anorexia → Lethargy → Thyroid issues (rule out) → Low Na+ → Overload of free water → Stupor/confusion → Sodium replacement needed

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BACK ME - Signs of HYPERcalcemia (High Ca2+)

Bone pain → Anorexia → Constipation → Kidney stones → Muscle weakness → ECG changes (short QT)

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CATS - Signs of HYPOcalcemia (Low Ca2+)

Convulsions → Arrhythmias → Tetany → Spasms (Chvostek's & Trousseau's signs)

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MAG Is Just LOW - HYPERmagnesemia Effects

Muscle weakness → Arrhythmias → GI symptoms → Is → Just → Loss of reflexes (early warning) → Obtunded → Weakness/respiratory arrest

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TWITCHES & TORSADES - HYPOmagnesemia

Twitching → Torsades de pointes (fatal arrhythmia)

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RIFLE - Acute Kidney Injury Staging

Risk → Injury → Failure → Loss (>4 weeks) → End-stage renal disease

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WEIGHS - Dialysis Assessment

Weight (daily) → Electrolytes → Intake & output → Grafts/fistula check → Hypotension risk → Symptoms of fluid overload

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CATEGORY 5 - ACID-BASE BALANCE

ROME - Interpreting ABGs

Respiratory Opposite → Metabolic Equal

• Respiratory disorders: pH and PaCO2 move in OPPOSITE directions
• Metabolic disorders: pH and HCO3 move in the SAME direction

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TICS - Metabolic Acidosis Causes

Toxins (aspirin, methanol, ethanol overdose) → Insulin lack (DKA) → Chronic kidney disease → Shock (lactic acidosis)

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MUDPILES - Anion Gap Metabolic Acidosis

Methanol → Uremia → DKA → Propylene glycol → Infection/sepsis → Lactic acidosis → Ethylene glycol → Salicylates

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DARE - Respiratory Acidosis Causes

Drugs (opioids, sedatives) → Airway obstruction → Respiratory muscle failure → Emphysema/COPD

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LOBE - Respiratory Alkalosis Causes

Liver failure → Oxygen (hypoxia compensation) → Brain injury → Emotional (anxiety, hyperventilation)

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CATEGORY 6 - CARDIOVASCULAR & RESPIRATORY

CHEST PAIN - Cardiac Assessment

Character → History → ECG changes → ST changes → Time of onset → Precipitating factors → Associated symptoms → Intensity (0-10) → Nitro response

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FAST - Stroke Recognition

Facial drooping → Arm weakness → Speech difficulty → Time to call emergency

Balance → Eyes (vision changes) → Face → Arm → Speech → Time

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PLEASE READ HIS TEXT - Cor Pulmonale Signs

Pitting edema → Right ventricle hypertrophy → Elevated JVP → Ascites → Signs of hypoxia → Exertional dyspnea → Respiratory changes → Edema (peripheral) → Ankle swelling → Distended neck veins → Hepatomegaly → Increased CVP → Split S2 → Tachycardia → Exercise intolerance → Xertional fatigue

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3 Ps of Diabetes (Hyperglycemia) - HYPERglycemia

Polyuria → Polydipsia → Polyphagia

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"Hot and Dry = Sugar High, Cold and Clammy = Need Some Candy"

• Hyperglycemia: Hot, dry, flushed skin (dehydrated)
• Hypoglycemia: Cool, clammy, diaphoretic (adrenergic response)

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WILLIAM MARROW - Bundle Branch Blocks (ECG)

WiLLiaM = LBBB: W pattern in V1, M pattern in V6 MaRRoW = RBBB: M pattern in V1, W pattern in V6

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VEAL CHOP - Fetal Heart Rate Monitoring

Variable decelerations = Cord compression Early decelerations = Head compression Accelerations = OK (good sign) Late decelerations = Placental insufficiency (EMERGENCY - turn patient, O2, call MD)

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CATEGORY 7 - MUSCULOSKELETAL & NEURO

5 Ps of Compartment Syndrome

Pain (severe, out of proportion) → Pallor → Pulselessness → Parasthesia → Paralysis

Extra: 6th P = Pressure (palpable tenseness over the compartment)

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PRICE/PRICEM - Musculoskeletal Injury Treatment

Protection → Rest → Ice → Compression → Elevation → Medication (analgesics)

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GLASCOW - Neuro Assessment Components

Eye opening (1-4) + Verbal response (1-5) + Motor response (1-6) = Total 3-15

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AEIOU TIPS - Causes of Altered Mental Status

Alcohol/Drugs → Epilepsy (post-ictal) → Infection (meningitis, sepsis) → Overdose → Uremia (renal failure) → Trauma → Insulin (hypo/hyperglycemia) → Psychiatric → Stroke/Structural

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PERRLA - Eye Assessment

Pupils Equal Round Reactive to Light and Accommodation

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CNOT - Cranial Nerves by Number (alternative to long lists)

"On Old Olympus Towering Tops A Finn And German Viewed Some Hops" Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Acoustic (Vestibulocochlear), Glossopharyngeal, Vagus, Spinal accessory, Hypoglossal

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CATEGORY 8 - GI & HEPATIC

FFFFF - Gallstone Risk Factors (Cholelithiasis)

Female → Fat → Forty → Fertile → Fair-skinned (or Family history)

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BRAT Diet - Post-GI illness

Bananas → Rice → Applesauce → Toast

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CRAP - Crohn's Disease Features

Cobblestone appearance → Right lower quadrant pain → All layers of bowel affected (transmural) → Perianal fistulas/skip lesions

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PUSH - Ulcerative Colitis Features

Pseudopolyps → Ulcers → Superficial mucosa only → Hemorrhage/bloody diarrhea

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CATEGORY 9 - MATERNITY & OB

BUBBLE - Postpartum Assessment

Breasts → Uterus → Bowel → Bladder → Lochia → Episiotomy/incision/extremities

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HELLP - Severe Preeclampsia Complication

Hemolysis → Elevated Liver enzymes → Low Platelets

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TORCH - Congenital Infections

Toxoplasmosis → Other (syphilis, HIV, Zika, parvovirus) → Rubella → Cytomegalovirus (CMV) → Herpes simplex

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TRAMP - Postpartum Hemorrhage Causes

Tone (uterine atony - #1 cause) → Retained tissue (placenta) → Atonic uterus → Maternal coagulopathy → Placenta previa/accreta

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APGAR - Newborn Assessment (at 1 and 5 minutes)

Appearance (color) → Pulse (heart rate) → Grimace (reflex irritability) → Activity (muscle tone) → Respiration

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COAT - OB Complications Requiring Immediate Action

Cord prolapse → Obstructed labor → Abruption (placental) → Transverse lie

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CATEGORY 10 - PEDIATRICS

FACES/FLACC - Pediatric Pain Assessment

Face → Legs → Activity → Cry → Consolability (scored 0-2 each, total 0-10)

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BLOCK 6 at 2 - Developmental Milestone

Child can stack a tower of 6 blocks by age 2 years

• 3-4 months: social smile
• 6 months: sits with support
• 9 months: pincer grasp
• 12 months: walks, says "mama/dada"
• 18 months: 10-word vocabulary
• 2 years: 2-word phrases, runs

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SAVE A CHILD - Pediatric Emergency Priorities

Size (use weight-based dosing) → Airway (proportionally larger head = sniffing position) → Vein access → Epiglottis (larger, floppy) → Anxiety management → Cold (hypothermia risk) → Heart rate is key (not BP) → Infection (immature immunity) → Liver (immature metabolism) → Development (use age-appropriate communication)

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CATEGORY 11 - MENTAL HEALTH & PSYCHIATRIC NURSING

DIG FAST - Signs of Mania (Bipolar I)

Distractibility → Impulsivity → Grandiosity → Flight of ideas → Activity increased → Sleep decreased → Talkativeness (pressured speech)

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SAD PERSONS - Suicide Risk Assessment

Sex (male higher completion risk) → Age (elderly + adolescent) → Depression → Previous attempt (#1 predictor) → Ethanol/substance use → Rational thinking loss → Social support lacking → Organized plan → No spouse/partner → Sickness (chronic illness)

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5 A's of Alzheimer's Disease

Amnesia (memory loss) → Aphasia (language) → Apraxia (motor skills) → Agnosia (recognition) → Attentional deficits (executive function)

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BATTED - Risk Factors for Elder Abuse

Bedbound → Alcohol/substance abuse (caregiver) → Threats observed → Trauma signs → External control (isolated) → Dependence (financial/physical)

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TRAP - Therapeutic Communication Blocks (What NOT to do)

Threatening → Reassuring falsely → Advising → Probing

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HALT - Non-therapeutic communication patterns

Hiding behind routine → Avoiding the patient's problem → Lecturing/moralizing → Telling what they should feel

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CATEGORY 12 - INFECTION CONTROL & ISOLATION

MTV - Airborne Precautions

Measles → Tuberculosis (TB) → Varicella (chickenpox)

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SPIDERMAN - Droplet Precautions

Scarlet fever → Pertussis (whooping cough) → Influenza → Diphtheria → Epiglottitis → Rubella → Adenovirus → Mumps → Adrenal plague (pneumonic) → Neisseria meningitidis

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MRS WEE - Contact Precautions

MRSA → RSV → Skin infections (impetigo, scabies) → Wounds (draining) → Enteric infections (C. diff) → Ebola

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DONNING & DOFFING Order

Gown → Mask/respirator → Goggles/face shield → Gloves

Gloves → Goggles → Gown → Mask

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CATEGORY 13 - ENDOCRINE & CANCER

3 Ps - Diabetes Hyperglycemia

Polyuria (excess urination) → Polydipsia (excess thirst) → Polyphagia (excess hunger)

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DKA vs HHS (Hyperosmolar Hyperglycemic State)

DKA: BOTH Type 1 and Type 2, acidosis, ketones, glucose usually >250 HHS: Type 2 mainly, NO acidosis, NO ketones, glucose >600 (very high)

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CAUTION - Cancer Warning Signs

Change in bowel/bladder habits → Asore that doesn't heal → Unusual bleeding/discharge → Thickening/lump in breast or elsewhere → Indigestion or difficulty swallowing → Obvious change in a wart or mole → Nagging cough or hoarseness

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FAME - Infective Endocarditis Signs

Fever → Anemia → Murmur (new or changing) → Embolism (Janeway lesions, Osler nodes, splinter hemorrhages)

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CATEGORY 14 - RESPIRATORY

4 Ds of Epiglottitis (Pediatric Emergency)

Drooling → Dysphagia → Dysphonia (muffled "hot potato" voice) → Distress (tripod position)

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COPD Nursing Tips - "Pink Puffer vs Blue Bloater"

Pink Puffer = Emphysema (barrel chest, pursed-lip breathing, uses accessory muscles, thin) Blue Bloater = Chronic Bronchitis (cyanosis, productive cough, obese, edema)

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ASTHMA Attack - "SABA First"

Short-Acting Beta Agonist (albuterol) first in acute attack, then assess response

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CATEGORY 15 - MISC / HIGH-YIELD

5 Rights of Medication Administration

Right patient → Right drug → Right dose → Right route → Right time

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"Clouds Over Grass, Smoke Over Fire" - ECG Lead Placement

White (clouds) over Green (grass) = White lead above Green lead Black (smoke) over Red (fire) = Black lead above Red lead Brown goes on the stomach (precordial leads)

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PRICE - Fracture/Sprain First Aid

Protection → Rest → Ice → Compression → Elevation

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THINK - Before Intervening

Therapeutic? → Harmful? → Informed consent? → Nurse competent? → Keep patient safe?

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Quick Master Index

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