Interpreting results from an arterial blood gas (ABG)

analysis followed by an ECG from the same patient. For

example, you might be shown an ABG of type 1 respiratory failure, which may be followed by an ECG showing
sinus tachycardia. You might then be asked for the most
important differential diagnosis (which in this case is
pulmonary embolism).
Interpreting a chest X-ray followed by an ECG from
the same patient. For example, you may be shown a
chest X-ray with diffuse reticulonodular shadowing followed by an ECG with right-heart strain pattern and
then be asked the most important differential diagnosis
(in this case cor pulmonale secondary to fibrotic lung
disease).
An ECG followed by viva questions, for example the
causes of hypokalaemia or hyperkalaemia.

Questions you could be asked

differential diagnosis and further investigations at

the end.
Management of common medical emergencies: The
traces you will be shown in the exam are likely to relate
to commonly encountered medical emergencies such as
acute coronary syndrome, arrhythmias and serious
electrolyte disturbances. You must remember the need
to resuscitate an acutely ill patient with respect to ABC
(covered in detail in other stations) before proceeding
to further specific steps in management outlined in the
table above.

Potential variations at this station

An ECG spot diagnosis of a shockable rhythm followed by the advanced life support management
protocol.

Q. Where is the isoelectric point?

A. The point at which the P wave begins to rise on the
ECG.
Q. What are the posterior chest leads?
A. Leads V7V9 (useful if a posterior infarct is
suspected).
You may also be given the following ECGs or ECGrelated scenarios to interpret:
Chest X-ray, for example cardiomegaly,+related
ECG
ABG, for example of type 1 respiratory failure,+
ECG reflecting pulmonary embolism; type 2 respiratory failure+right heart strain ECG showing cor
pulmonale; lactic acidosis/ increased troponin+ST
segment elevation
ECG+advanced life support
ECG+viva (e.g. causes of hyperkalaemia)
ECG+focused history (e.g. to rule out contraindications to thrombolysis)

Reference
National Institute for Health and Clinical Excellence
(2006) Atrial fibrillation: the management of
atrial fibrillation. Available from: www.nice.org.uk/
nicemedia/live/10982/30054/30054.pdf
(accessed
June 2012).