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One of the unfortunate consequences of busier ED’s is we do more of everything. Every shift, most of us see over 20 ECG’s, sometimes more.

To perform we have to be faster and smarter – thus the 20 second ECG. See more, miss less. See more patients with less staff etc. We need to make sure we don’t miss the big stuff.

Literally, we can all look at an ECG and in 20 seconds decide if it’s bad or not. I’m not talking about your anterior fascicular block, who cares, last time I checked, it didn’t kill anybody. I want the chunky stuff. I want to rule out ischaemia and arrhythmia. If I find those things, then I can pull out the set square, mathematical calculator, put my nerd brain into gear and spend a few minutes.

The rest of the time I want to know if the patient is having ischaemia, an infarct, a brady-arrhythmia or a tachy-arrhythmia.

With the 20 second ECG, we do it. It picks up 95% plus I would say. Here’s a great study, how many bad things do we miss if we use the 20 second method?

So here is the video. It’s free for this week on


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