FAQ - Monitor technician course online

Reviewed by Judy Haluka

• I was looking at your rhythm strip flash cards and i discover a mistake. the strip 14 answer is atrial fibrillation, the problem is that the rhythm is regular

  It is atrial fibrillation. That rhythm is irregular however you can have a perfectly regular atrial fibrillation if there is a complete block at the av nodal level snd the ventricular response is junctional or ventricular.

• I am confused by the two images (ecgs) at the bottom of section 2. using your criteria for a quick assessment of axis deviation to try to interpret the images, it appears to me that in both images, the qrs is primarily positive in lead i and negative in lead avf. that would make both of them cases of left axis deviation. what am i missing, or can you provide more detailed instruction, please? this is for the 12-lead course

  The first is a left acis deviation and the second is a right axis deviation. The first is postive in lead i and negative in avf making it a left axis deviation.

• would somebody please be able to help me interpret these rhythms i keep going round and round trying to figure these out
  1. would it be a idioventricular rhythm or premature junction contraction?
  2. multifocal atrial tachycardia or atrial fibrillation with rapid ventricular response?
  3. complete heart block or first degree heart block?
  4. complete av block or first degree av block type 2

  1. junctional with bbb

  2. mat

  3. long 1st degree

  4. complete heart block

• a pvc that occurs during the relative refactory period is referred to as
  Bigeminy, a couplet, bbb, r-on t phenomenon

  R-on t

• on a standard ecg paper the horizontal lines are a measurement of
  1. pacing, voltage, capture, or pulse width.
  2. i know horizontal lines are a measurement of time?

  None of those are the answer. The correct answer is time

• i am reaching out from nemours children’s health system in florida to inquire if your cct program includes training in pediatric stress(to include ett stress, stress echo, pharmacological stress, nuclear stress, ergometer, 6 min walk test and research stress) holter, 30/60 day cem and mct monitoring, pacemakers as well as tilt training? currently we have 4 candidates in line for pediatric cct positions but would like to find a structured initial training course for them. if you do offer those portions for pediatrics, please forward me a course outline and cost per student

  No pediatric diagnostics are an entirely separate entity. Kids are much more than just smaller adults. Even on a physician level an adult cardiologist cannot test pediatrics

• is ectopy, ectopic beats, and artifacts covered in this course?

  Yes

• i was curious if you know the legal responsibilities of a telemetry technician in washington state or know where i can find them. i work with a few techs in this department and the hospital is not allowing them to save their strips to the chart without the nurse signing them off. in most cases they do, but every once in a while they don’t and the hard work of the techs are lost. this gives rise to strips that occur during emergencies and lack of sing-off from the nurses that may leave the tech looking like they did not notify the nurse or even look into that patient. i appreciate your time, and look forward to hearing from you

  I do not see any info on the washington state dept of health website pertaining to telemetry technicians. I also checked with our medical experts to see if they knew anything about this and they replied that it is most likely a matter of policy. The technician is not licensed and therefore the nurse must oversee their work as it affects the patient.

• i have read through your syllabus and course description and i would like to learn how to perform the holter monitor and stress tests by taking this certification course. the only thing i find confusing about your page is the registration page where it says 12-lead electrocardiography... now when i look at pictures online of a holter monitor it appears as though majority of the time it’s only a 5-lead. so when you say 12-lead electrocardiography= $300 you are referring to learning not only the 12-lead but also the 3, 4, and 5-lead?

  The holter monitor is done for arrhythmia detection. The 12-lead ecg is done for diagnosis of fixed cardiac abnormality, ischemia, and infarction. They are two completely different things. You would benefit more from the arrhythmia course.

• is there anything about the "axis" that will be on the test? i assume it will be covered more in the 12-lead ecg course instead. but, i don't want to make any assumptions

  Axis can only be determined with a 12-lead ecg and so is not covered in arrhythmia.

• for many certification exams one must certify completion of 10 successful ekgs performed prior to testing, how do students complete this if the course is fully online?

  Our course is designed for the student looking to take the cci cct and crat exams. And we are acceptable for that purpose -- the cci even lists us on their website as a recommended study program.

• why does your course have 6 sections and your exam tests over 7 sections?

  Sections 1 through 6 of the exam have a one to one correspondence with sections in the course. Questions in section 7 of the exam may correspond to any of the 6 course sections because those questions cover the identification of rhythms, which are found throughout the course.

• can i still access the course materials after i have passed the course?

  Yes. If it's been longer than a year since your last log in, you may need to contact us first so you can log in. Send us an email with your order number and let us know you are trying to access a course and have not logged into your account in over a year.

• i am partially color blind(color deficient). i was wondering if this prohibits me from becoming a monitor/ekg technician?

  No, as most ecg monitors are green, but it doesn't matter how you would see them as far as color. Nothing changes colorwise with arrhythmias. It should have no affect.

• are there practice strips included in the training which involve measuring intervals?

  All require measuring intervals in order to diagnose the rhythm, i.e., heart blocks. The book is the printed course material.

• what book is utilized for this course?

  The book is the printed course material supplied online.

• does your arrhythmia course include any information regarding pacemaker rhythms?

  Yes, the arrhythmia course does cover pacemaker rhythms. We have a rhythm strip flash cards page as well as the practice rhythms in our stress test course. See the flash cards page at our rhythm strip practice page.

• where can i find more information on ventricular assist devices (vads)?

  University of Pittsburgh Cardiac Transplantation Program. Pittsburgh, PA. They have both a wonderful program and a lot of resources available.

• i need clarification regarding the time ecg should be preformed
  on step 4 of the algorithm you mention that "obtain a 12-lead ecg and assess for arrhythmias." followed by "do not delay the ct scan to obtain the ecg..."
  what do you mean by "do not delay the ct scan." if every action from step 4 is done except the ecg and ct team is ready to receive the patient, should i do an ecg as long as it doesn't exceed the set 25minutes goal from door to ct or should i delay the ecg until after the ct scan is done. hugo arsenio.

  No, what it means is if the ct scanner is available, do it and do the ecg after the ct. You want the ct done as early as possible so that diagnosis can be made.

• i am a risk consultant with illinois risk management services. we provide risk and claims management and consulting services to hospital clients throughout illinois. one of our hospital clients has expanded their telemetry monitoring to include icu, step-down, and medical surgical beds; one tech is currently monitoring up to 48 patients, plus potentially 8 icu bedside monitors. another hospital client in their system has established a threshold of 50 patients before requiring a second monitoring tech. the hospitals have asked for our opinion, from a risk management standpoint, re: an appropriate monitor tech to patient ratio
  we would appropriately reference you (or any other source if you provide information from additional sources) in any opinion or advice (written or verbal) we provide to this client or any future clients.

  There are no written guidelines, however i trained the monitor techs at allegheny and they routinely watch a 42 bed telemetry unit.

• does your stress test and holter monitor course cover 3-lead, 4-lead, and 5-lead?

  Yes.

• i recently took the practice test for the crat by cci and it let me know where i need to improve on. i need to learn about patient registering, maintaining cardiac monitoring device support, educating patients, and administrating cardiac tests. can you confirm which course covers these subjects, or put me in touch with someone who can?

  We really do not have a course that would be helpful to him.

• i have some comments on the interpretation. i agree with the interpretation of the 1st12l - sr, 1avb, lblb. however, #2 ecg is st vs at (vs slow afl) chb, with ventricular escape rhythm from the left posterior fascicle (rbbb + lafB pattern). i have marked the p waves and some p waves are hidden from view. the rr interval is regular. so, this makes chb very likely
  (image)
  for ecg # 3 & 4. yes, i agree this is ventricular standstill with pause-dependent polymorphic vt. tdp is a variant of tdp with a documented long qt/qtc.

  Our interpretation is for basic purposes.