EKG/ECG Abnormal

Also Consider:  Chest Pain, Heart Rate, Shortness of Breath, Vomiting 

1. Take Vital Signs

• Temperature:

• Blood Pressure:

• Heart Rate: 

• Respiratory Rate:

• Oxygen Saturation:

2. Evaluate Symptoms and Signs

• Acute mental status change

• Not eating or drinking as much as usual

• If Pain:  exact locations, pain scale, description (sharp, dull, burning), persistent or intermittent

• Fainting, dizziness or lightheadedness when standing up

• Acute decline in ADL abilities

• Diaphoresis: Cold, clammy, pale skin

• Respiratory: shortness of breath, abnormal lung sounds, Accessory muscle breathing, pursed lip breathing, Respiratory distress

• Cardiovascular:  Chest pain, palpitations, new irregular pulse, cyanosis, mottling, edema

• GI: Nausea, vomiting, diarrhea, abdominal distention or tenderness, rebound tenderness, bowel sounds

• Neurologic  changes: consciousness/alertness, orientation, weakness, gait changes (unsteadiness, loss of coordination or balance)

• Response to any ordered PRN medications (nitroglycerin, oxygen) or repositioning

• Fingerstick glucose (patients with diabetes)

3. Take Action using SBAR Report:

• Immediately notify the medical staff & resident representative

  • Abnormal EKG accompanied by other acute symptoms

• Notify medical staff on the next business day 

  • Changes in routine EKG from prior study, without any acute symptoms

• Notify medical staff at the next regular rounds 

  • Results of a routine EKG that are unchanged 

4. Implement Management Plan

• Monitor vital signs every 4-8 hrs for 2-3 days

• Offer fluids frequently

• Place on Intake & Output monitoring

• Monitor meal acceptance

• Place on 24-hour report for 2-3 days

• Obtain lab results (if ordered), and notify medical as needed of:

• Significantly abnormal values in lab tests (refer to appropriate Situation)

• Abnormal Troponin

• Review status and plan of care with designated representative with any changes

• Update advance directives if appropriate

2025-04-27