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How much do I need to know about ECG’s to pass ACLS?

By Judy Borish RN, MSN, CCRN-K, PCCN-K,  ACLS instructor at CPR Seattle


Throughout my years of teaching ACLS, I have fielded many questions on class preparation in regard to ECG’s:

  • Do I need to be an expert on ECG’s?
  • Can I still pass if I miss all the questions on cardiac rhythms?
  • I don’t work with cardiac rhythms.  Why do I have to know this for ACLS?

Understanding and responding to ECG’s and ECG changes is a major component of ACLS, so you do need to know the basics of arrhythmia interpretation. How much do you need to know about ECGs to pass an ACLS class? You need to recognize types of:

  • bradycardias (slow rhythms)
  • tachycardias (fast rhythms)
  • and life-threatening rhythms (ventricular tachycardia, ventricular fibrillation, and ventricular asystole).

Everyone taking an ACLS course is required to take the same exam and pass the same mega code.  This is easier for healthcare professionals who work in critical care situations on a daily basis.  They see and interpret cardiac rhythms all the time.  Critical Care and ED nurses, physicians, and medics aren’t the only professionals required to take ACLS.  ACLS certification is a requirement for providers in a wide range of clinical practices, including many physicians, anesthesiologists, pharmacists, out-patient clinics performing conscious sedation, respiratory therapists, physician assistants, nurse practitioners, and dentists.

If you don’t work in a setting where you read and interpret ECGs frequently, cardiac rhythms may be a difficult part of ACLS for you. Seeing and studying the rhythms once every two years is not enough to remember and recognize them. So that brings us to another important question:

How can I get proficient enough in arrhythmia interpretation to pass ACLS?

There are a number of ways to accomplish your goal.  Which method you pick depends on your learning style and your background. Remember to give yourself time to study before taking the ACLS class. Some options include:

  • Read and study the ACLS manual.  This will work if you have a firm foundation and need a quick refresher.
  • Online arrhythmia courses.  There is a wide variety available including YouTube videos.  Some are better than others.  This works well for some learners.
  • In-person review class.  CPR Seattle offers 2 courses on a quarterly basis. This method works well for people looking for individual attention and interaction.

I want to give you a little more detail about the classes we offer at CPR Seattle.  I teach both of these classes. I have been a critical care nurse for 45 years and have taught arrhythmia interpretation for 40+ years.  It is my very favorite thing to teach! I have also been an ACLS Instructor for 25+ years.

We offer a 6-hour class, ECG Interpretation Made Easy, that is designed for students with little or no ECG knowledge.  It begins with the very basics of waves and intervals, then progresses on to the arrhythmias needed for ACLS.  It looks at bradycardias, tachycardias, and life-threatening arrhythmias.

We also offer a 4-hour course, ECG Interpretation Review.  This course is designed for students with limited ECG knowledge who already know ECG waves and intervals but still need a review of arrhythmias needed in ACLS or ACLS Renewal.

If you have a group that wants to take either of these ECG courses, CPR Seattle can also teach them at your place of work. 

I hope this answers some questions.  Good luck.




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Published on May 16, 2022