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12-Lead EKG & Chest X-Ray Interpretation:
CE Test
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  1. Review normal 12-Lead EKG and the polarity of each lead
  2. Identify axis deviation and implication in clinical practice
  3. Discuss the criteria, causes, and significance of left and right bundle branch blocks
  4. Analyze EKG changes associated with ischemia, injury, and infarction patterns
  5. Develop a quick approach to diagnosis of STEMI on 12-lead EKG
  6. Analyze EKGs for subtle and high-risk signs
  7. Develop a systematic approach to chest X-ray interpretation
  8. Identify correct placement of common invasive lines on chest X-rays
  9. Differentiate between common cardiac and pulmonary disorders on chest X-rays
  10. Discover the clinical pearls of EKG and chest X-rays in challenging case studies

12-Lead EKG 101
  • Cardiac electrical conduction system
  • Electrical vectors
    • Introduction to the 12-leads
      • Limb leads
      • Augmented leads
      • Chest leads
  • Normal polarity and P-QRS-T configuration of each lead
Ace the Axis
  • Left and right axis deviation
  • Causes and criteria of axis deviation
  • Methods to determine axis deviation
  • Case presentations, analysis, and clinical application
Beat the Bundles
  • Right and left bundle branch blocks (BBB)
  • Criteria for right vs. left BBB
  • Causes and complications of right and left BBB
  • Left anterior and left posterior hemiblocks
  • Case presentations, analysis, and clinical application
Correlate the Coronary Anatomy
  • Coronary arteries
    • Right coronary artery (RCA)
    • Left coronary artery (LCA)
    • Left anterior descending artery (LAD)
    • Circumflex artery (CX)
    • Posterior descending artery (PDA)
  • Left ventricular walls
    • Inferior
    • Anterior
    • Septal
    • Lateral
    • Posterior
  • Relationship of coronary arteries and ventricular walls to the 12-leads
    • Inferior—RCA—leads II, III, AVF
    • Anterior/septal—LAD—leads V1–V4
    • Lateral—circumflex—leads I, AVL, V5, V6
    • Posterior—PDA—reciprocal changes V1–V4
Differential Diagnosis: 12-Lead EKG in Acute Coronary Syndrome
  • Ischemia pattern
  • Injury pattern
  • Infarction pattern
  • Reciprocal changes
  • ST segment elevation myocardial infarction (STEMI)
  • Non-ST segment elevation myocardial infarction (NSTEMI)
  • Coronary spasm
  • Takotsubo cardiomyopathy (broken heart syndrome)
Example and analysis time - Piecing it all together
  • 30-second diagnosis of STEMI on 12-lead EKG
  • Coronary angiographic correlation to 12-lead EKG
  • Case presentations, analysis, and clinical application
Advanced 12-Lead: Challenging Clinical Presentations
  • Atrial and ventricular hypertrophy
  • Wolff-Parkinson-White syndrome
  • Prolonged QT intervals
Note: Most chest X-ray examples will be AP films

Chest X-ray basics
  • Technique
  • Black and white principles
  • Projections
    • Anterior-posterior (AP)
    • Posterior-anterior (PA)
    • Lateral
Systematic Approach
  • Bone structures
  • Intercostal spaces
  • Soft tissues
  • Lungs/trachea/pulmonary vasculature
  • Pleural surfaces
  • Diaphragm
  • Mediastinum
  • Heart and great vessels
  • Invasive lines
As Easy as Black
  • Pneumothorax
  • Subcutaneous emphysema
  • Clinical application and treatment
As Easy as White
  • Pleural effusion
  • Pulmonary edema
  • Pneumonia
  • Atelectasis
  • Acute respiratory distress syndrome (ARDS)
  • Cardiomyopathy
  • Pericardial effusion
  • Cardiac tamponade
  • Clinical application and treatment
Beyond the Basics
  • Aortic aneurysm
  • Post-op changes with pneumonectomy
  • Hydropneumothorax
  • Esophagogastrectomy
  • Dextrocardia
  • Clinical application and treatment


Cheryl Herrmann, RN, MS, APRN, CCRN, CCNS-CSC/CMC, is an expert in cardiac care and a popular presenter at AACN National Teaching Institute and regional conferences. Past participants comment “how much they have learned as Cheryl takes complex concepts and makes them easy to understand!” “Cheryl doesn’t just lecture, she “teaches” and gives practical take-home strategies to implement into practice”. Back in 1996, Ms Herrmann’s research thesis was on Women and Heart Disease. Since then she has been an advocate for educating the medical field and public on awareness for heart disease in women.

Ms Herrmann has a passion for cardiac nursing and has over 35 years of cardiac nursing experience in the prehospital EMS, acute and critical care, cardiology clinic and mission field. In addition, she is an author and reviewer for nursing journals, one of which, Critical Care Clinics, published her article "A Woman's Heart is Different." In 2005, Ms. Herrmann was honored with the American Association of Critical-Care Nurses Circle of Excellence—Excellent Clinical Nurse Specialist Award and the Twenty-Five Women in Leadership.

Cheryl Herrmann, cardiac clinical nurse specialist, presents material in a way that all health professionals caring for the cardiac patient, regardless of where they are in the continuum, take home valuable knowledge and new skills. For more information about Ms. Herrmann, please visit>

Speaker Disclosures:

Financial: Cheryl D. Herrmann has an employment relationship with UnityPoint Health Cardiology. She receives a speaking honorarium from PESI, Inc.

Non-financial: Cheryl D. Herrmann is a member of the Illinois Society of Advanced Practice Nurses and National Association of Clinical Nurse Specialists.
Continuing Education Credits
Save time and $10 off the price of other submission methods – purchase & take the CE test online for $9.99 USD per participant. Additional processing fees apply for other submission methods (i.e. mail, fax, etc.). Please contact our Customer Service at 1-800-844-8260 for more details.

Listed below are the continuing education credit(s) currently available for this non-interactive self-study package. Please note, your state licensing board dictates whether self study is an acceptable form of continuing education. Please refer to your state rules and regulations.

Certificates of Successful Completion are available for email, download and/or printing from your online account immediately following the successful completion of the post-test/evaluation.

**Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of mental health professionals. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your professions standards.

The planning committee and staff who controlled the content of this activity have no relevant financial relationships to disclose. For speaker disclosures, please see speaker bios.

Nurses/Nurse Practitioners/Clinical Nurse Specialists - Credit Expired: 6/2/2018
No CE available for this board.

California Nurses: PESI, Inc. is a provider approved by the California Board of Registered Nursing, Provider #:17118 for 5.0 self-study contact hours.

You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

Florida Nurses:
PESI, Inc. is an approved provider by the Florida Board of Nursing. Provider #: FBN2858. These materials qualify for 5.0 self-study contact hours.

Iowa Nurses: PESI, Inc. is an approved provider by the Iowa Board of Nursing. Provider #: 346. Nurses successfully completing these self-study materials will earn 5.2 self-study contact hours.

Copies of the evaluation may be sent to the IBON. You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

Other Professions
This self-study activity qualifies for 5.25 clock hours of instructional content as required by many national, state and local licensing boards and professional organizations. Retain your certificate of completion and contact your board or organization for specific filing requirements.

Disclaimer: **Information obtained in this course should be used within your scope of practice.
**It is your ethical responsibility to report accurate hours to your licensing board.
**All self-study participants must complete and pass (80% or better) a post-test/evaluation prior to receiving a certificate of completion. If you require a copy of the test/evaluation for CE purposes, please print at the time you take the test. Or you may call our customer service department and a copy of your test/evaluation will be emailed to you. Please allow 30-45 days.

  • Acute Care and Family Nurse Practitioners
  • Registered Nurses in:
    • Critical and Intensive Care
    • Acute Care
    • Cardiac Care
    • Emergency Department
    • Physician Offices, Physician Assistants
    • Clinical Nurse Specialists
    • Medical Assistants
    • Emergency Medical Technicians
    • Paramedics
    • Respiratory Therapists

Cheryl is an expert—great experiences. I really like the clinical examples and case studies to relate to evidence-based practice.
Cynthia Peters, RN
Blue Springs, MO

Cheryl Herrmann is an excellent speaker. She has great pearls for learning.
Denise Stoerkel, RN
Willoughby, OH

Well done. Interesting examples and real-life application.
Diane Indermuhle, RN
Wooster, OH