Lesson 11 of 21 · Axis & Interpretation
A Systematic Approach
Read every EKG in the same order, every time. A system prevents the most common error: seeing one obvious finding and missing the second.
01The 8-step read
- 1. Patient ID, calibration, comparison with prior
- 2. Rate
- 3. Rhythm: P before every QRS? QRS after every P? Regular?
- 4. Axis
- 5. Intervals: PR, QRS, QT/QTc
- 6. P-wave morphology (atrial enlargement)
- 7. QRS: hypertrophy, BBB, Q waves, R progression
- 8. ST segments and T waves, with reciprocal changes
02Then synthesize
Put it together in a single impression and, crucially, compare with a prior EKG. 'New' is what makes ST changes, BBB, or Q waves actionable.
Clinical pearl. Say what you see before you say what it means: 'wide-complex regular tachycardia at 170' comes before 'VT'.
Key takeaways
- Same order every time
- Rate → rhythm → axis → intervals → morphology → ST/T
- Always compare to prior