Disclaimer: Some of this advice I consider 'no duh' but I figured I'd say it just in case.

On shelf exams:

1. Yes, all of the case files/blue prints/UW/OME are good resources.
   
   
2. Emma Holiday's clerkship review videos are all excellent.
   
   
3. If you're a DO peep and have to take COMAT shelf exams, go ahead and shell out for the COMBANK exam specific question banks. Some of those questions will show up verbatim on exam day.
   
   
4. If you haven't already, download the mobile app for UWorld, Kaplan, and/or Combank. Some of my preceptors actively encouraged me to do questions while they were charting and would jump in to work through some with me when we had downtime in the clinic.
   
   On electronic devices and apps:
   
   
5. I got an iPad mini at the start of the year and loved having it but it is not at all necessary.
   
   
6. Some people recommended starting off each rotation by saying to your attending/upper level "I have electronic textbooks/apps, is it okay if I use them while I'm with you?" (so that you're not accused of texting or being on facebook 24/7) but that was honestly never an issue for me.
   
   
7. Good apps to have: MDCalc (free), ASCVD Risk Estimator (free), Nodule (free), UpToDate (some hospitals will give you an institutional log-in if your school doesn't), GoodRx (free), Epocrates (free-ish), and palmEM ($10 but a decent investment if you're an EM gunner).
   
   On boards:
   
   
8. The best time to sign up for your Step 2 CS/Level 2 PE is the second you get authorization from your school. Those spots go quick.
   
   
9. DO peeps: the NBOME has affiliate deals with hotels for reduced rates. You can find the links and info here. Yes, this whole thing is stupid expensive but you might as well take advantage of what little silver lining there is.
   
   
10. If you need disability accommodations (extra time, electronic stethoscope), start those applications NOW. There's a lot of little parts to them (I have no idea why they needed a letter from my dean but whateva) and the committee to approve those things only meets once a month (so if your application arrives after they've met for the month, you're basically going to be waiting two months to hear back from them.) Anyone who needs help with this or has questions can feel free to message me.
    
    
11. I have no idea when the best time to take the written tests are. It will depend on your individual schedule and goals.
    
    On wards:
    
    
12. You'll probably get a lot of (pocket) book recommendations. You do not need to buy every book recommended to you. The two I found useful this year were The Massachusetts General Hospital Handbook of Internal Medicine and Clinician's Guide to Laboratory Medicine.
    
    
13. Pre-round on your patients. Some people like the scutsheets from medfools but I found them a little constrictive once I knew what I was doing. If you are supposed to write an H&P, SOAP note, discharge summary, etc and your school didn't teach you, google it. There are a ton of decent guides out there.
    
    
14. You are there until your attending/resident explicitly tells you to go home. Your ability to ask to leave will depend on the culture +/- your gumption.
    
    
15. NEVER LIE. If you did not see the patient, you didn't see the patient.
    
    
16. Some people will tell you to always say "I don't know but I'll look that up and get back to you!" Honestly, my residents would roll their eyes and tell us to guess.
    
    
17. If you don't know where something minor is (cups, ice machine, extra pillows, extra blankets) ask to be shown so that the next time you can get it yourself. Yes, you will absolutely be asked to fetch people coffee, return that empty bed to the floor, help someone to the bathroom, grab an extra blanket, etc. Most people tend to think more highly of those that do this without groaning.
    
    
18. If you feel like you had a good time with a preceptor and they would be a useful addition to your application, consider asking them for a letter of rec at/near the end of your rotation. You don't have to apply every letter you upload for programs to see so there's really no harm in collecting more than three (but do not ask every single persona for a letter of rec - doctors talk about students, especially the ones they find sketchy or annoying).
    
    On evaluations:
    
    
19. I know the majority of this subreddit moans about how subjective and unfair evaluations are but my one point of pride this year is that every single preceptor gave me an honors level eval.
    
    
20. Yes, I am a woman. No, I am not attractive. I'm slightly below average to fair with a moderate amount of chunkiness.
    
    
21. Do anything you can to make your resident's life easier.
    
    
22. Be polite to every nurse, tech, nurse practitioner, receptionist, and office manager. Make small talk. Yes, I know you've heard this a million times. Yes, I did bake things and bring in boxes of donuts. Yes, you can call me a suck-up. I was still blown away when one office manager said to me "We really liked having you. None of the other students talk to us."
    
    
23. Be enthusiastic. Ask questions. Even if you're not interested in that specialty, you can still ask what applying to residency was like (for young doctors) or how things have changed since they started (for old doctors).
    
    
24. This is not the year to have debates. Some of my classmates got into arguments on guns, the president, or religion; sometimes the attending respected their chutzpah and sometimes they didn't. I preferred to play it safe.
    
    
25. Keep in mind every annoying social media professionalism lecture you've ever gotten. Techs, nurses, nurse practitioners, and more all wanted to add me as a friend on Facebook. Yes, you can choose not to add them (smartest move tbh) but I gave in after getting point-blank asked "why didn't you add me?!" Facebook is for that "magical feeling of wonder and joy" when you catch a baby for the first time or the "humbling awe" you felt when you first retracted the colon. Nothing else.
    
    
26. If you are sharing a rotation with NP student or PA student, treat them like another medical student and be cordial. Don't try to pimp them. Don't get into pissing contests. Doctors are expected to be leaders; now is your chance to actually demonstrate that.
    
    
    
    In general: Third year can be frustrating because it varies so wildly. Some of you will have cush rotations where you're done at 10:30 am. Some of you will enter the hospital before the sun rises and leave when it is setting. Some of you will feel like you're shadowing again. Some of you will be treated like interns (and abused because you don't have work-hour restrictions). Some will find out the thing they thought they wanted they hate and others will find out the thing they want is beyond their reach (because of family obligations, board scores, or another thing all together). Some of you will deliver 80 babies a month and some of you won't even do a Pap smear. Every hospital has a different culture; just be polite, professional, and let yourself be immersed. You'll pick it up soon enough.
    
    TL; DR: Life is short. Be excellent to each other.
    
    EDIT: Added some stuff, found out there's a size limit on comments, made a second part.

I recently underwent a similar change, having worked in outpatient orthopedics for 6-ish years (+lots of $$ spent on con-ed including manual therapy certification) and abruptly switching to acute care. My decision was spurred by increasingly high patient volumes (which seems to be a trend in Vegas OP) and an inability to provide what I would consider 1-on-1 patient care in a manner that fit my values. I've been in acute care for about 8 months now and haven't looked back. As a result of this, I do feel like a new graduate at times, but I've been excited to dig into new information and material, while enjoying the pace and exposure to a variety of conditions acute care offers.

Some things I've found useful thus far:

Don't be afraid to ask questions. Most of my fellow co-workers are younger than me, but have more experience in this area. Check your ego at the door.

I've found getting to know the nurses in each unit to be invaluable. Find them prior to seeing your patient, get any further information they may have regarding your patient (outside of your chart review) and discuss with them any pertinent findings of your evaluation.

Chart review! I want to know as much as I can regarding my patient's prior to seeing them. I mostly do evaluations and want to garner as much of a clinical picture as I can including lab values, vital trends, imaging findings / reports, physician notes, nursing notes, surgical reports, pending tests / labs, medications, etc. You can gain a lot of information from the electronic chart.

Vital signs on everyone. This is easier in the ICU where everyone is monitored, but on your ortho and med/surg floors I don't think I can under state this. I've run into countless asymptomatic people who upon assessment have systolic BP > 200, or more recently having a patient who's blood pressure dropped from 85 systolic to 50 systolic following 1 sit<>stand.

Collaboration with your fellow speech, occupational and respiratory therapists. I can be myopic at times, so getting input from findings from your other therapists can be helpful.

Having a good line of communication with your case managers. You are an advocate for your patients and need to have an open line of communication to discuss or challenge d/c recommendations.

Lines. Double check for any lines, tubes or catheters even if nothing stands out. Our electronic chart will tell me what lines are present upon chart review, but it doesn't hurt to double or triple check prior to mobilizing a patient.

Some resources I've found helpful as a new acute PT:

https://physicaltherapyreviewer.wordpress.com/
http://ptthinktank.com/2012/12/18/so-you-think-you-can-walk-acutept/
https://twitter.com/dr_ridge_dpt
https://twitter.com/DrDaleNeedham
www.medbridgeeducation.com ($200/yr with discount code, a number of courses focused on acute care)
http://www.amazon.com/Rapid-Interpretation-EKGs-Sixth-Dubin/dp/0912912065
http://c.ymcdn.com/sites/www.acutept.org/resource/resmgr/imported/labvalues.pdf

It's been a learning process with the transition, but I've been thoroughly enjoying it. Plus, I get the added benefit of seeing anatomy on a deeper level when it comes to wound care. Not to mention, the added benefit when you get your patients who are mechanically ventilated up and moving, while seeing their appreciation that they have for your services / help. Enjoy!

Really good question, but difficult to answer. It all depends on how you define "competent understanding of emergency medicine."

Listening to podcasts and whatnot is a great way to keep up with new advances, but most of the EM podcasts expect listeners to have a broad fund of knowledge. I think your time might be better spent focusing on getting a solid foundation in the basics. Here's my two cents.

1. Learn anatomy and medical terminology. Work on getting comfortable with medical lingo and use it (appropriately) in your reports. Medicine is about sounding smart as much as it is about being smart. For example, documenting that you noted "bilateral +2 lower extremity pitting edema extending to the knees" on a CHFer sounds a whole lot more professional than "lower legs swollen." Being able to describe physical exam findings accurately and professionally goes a long way and garners much respect.
   
   It's equally important to know when not to use certain medical terms, as there are quite a few words that carry an "oh shit" connotation. For example, do not describe an abdomen as "rigid" unless their belly feels like your palpating the tires of your ambulance. A true rigid abdomen means they need to be in the OR 2 hours ago. Do not a sleepy sick toddler as "lethargic" unless the kid is pretty much limp and lifeless. You'll end up scaring the shit out of your ED staff and/or making yourself look like an idiot.
   
   
2. Expand your physical exam and history taking abilities. You probably won't learn much more in the way of history/physical skills in medic class. Those are BLS skills. I highly recommend reading Bates. Not all of it is pertinent to EMS, but a lot of it is.
   
   Knowing which questions to ask is hugely important. Bates also covers a lot of terminology too, which goes back to point #1. For example, the whole "chest pain patient clutching fist to chest" thing they teach in EMT class...that has a name. That's a Levine's sign. And if you can accurately describe skin findings (eg "diffuse erythematous maculopapular rash" as opposed to "hives"), you'll look like a genius.
   
   
3. Learn physiology and pathophysiology. Read up on the diseases that they didn't teach you about in EMT class. Understand basic things like wheezing does not mean asthma.
   
   
4. Learn common drugs and their pharmacology, especially the ones you carry. Epocrates is a great way to start. Lange Basic and Clinical Pharmacology is a great reference. It's the standard pharm book for medical schools, but its great at explaining things in a way that's fairly easy to understand.
   
   
5. If you're curious about something, be proactive in finding out the answer. Look it up yourself or ask the medics you work with, ED staff, docs, etc.
   
   TL;DR- Never stop learning.
   
   
   
   

I agree with everything said in this thread, but to add some things:

I strongly recommend a good particle physics course. If you can think about the basic things in our field automatically in terms of Feynman diagrams and you know the rules of certain force interactions (everything but gravity being important, with EM and Weak force interactions slightly more important than strong in our field), I've found that helps me to understand the empirical/applied stuff a lot better.

I would seek to shadow as many medical physicists from as many different specialties as possible. It'll let you decide if you really want to be/what specifically you want to do in our field, as well as look good on any resume. I'd shoot for at least one shadowing session of clinical physicists in radiotherapy, nuclear medicine, and diagnostic imaging each, as well as a health physicist, and an undergrad internship at a company like Varian or Elekta (look to the AAPM for undergrad opportunities/funding). Some physicists appreciate teaching people while others don't, so don't give up if you're turned down on a cold call, but don't cold call the same person twice.

As a bonus, read Kahn, Attix, and Hall, if you have time. For Nuclear Med, I'd recommend Cherry, and for Diagnostic Imaging I'd recommend Bushburg. Definitely start with Kahn as it is the easiest to digest IMO. I'm sure others have book recommendations as well. Though, I wouldn't bother until you've at least taken your entry level classical mechanics and E&M courses, even then a lot wont click until you've taken Quantum 1.

Edit: oh also experience in programming will help. Matlab and/or python seem to be base in our field, though C++ cant hurt.

I would avoid test-prep books then-- those tend to skim the surface of things like pathophys and always seem to be more focused on important facts and associations, etc., and not on the science.

Sadly there is no quick answer for getting better at pathophys (it takes 2 years to cover the basics in med school). Working in an ED you don't have massive amounts of time to read either. As a resident I find myself wanting to review stuff all the time but am pretty busy too, so with that in mind, my recommendations would be:

-UpToDate/Dynamed/Medscape/etc. usually have nice sections in their articles on the pathophysiology of various conditions. The temptation is to skip to the "diagnosis" or "management" sections but there is usually some good stuff in those articles that you can read on the fly

-For critical illness and general physiology, The ICU Book is great and not too dry a read. If you want much more in depth stuff on medical conditions, Harrison's Internal Medicine is a great resource but reads like a phonebook sometimes. If you care about the microscopic level, Robbins & Cotran is basically all the pathology for the non-pathologist you will ever need- can also be a bit dry at times too.

-Look up the mechanism of action of meds you don't know about (Micromedex smart phone app is great for that)

-When you consult someone because you are unsure about something, ask them about what is going on (subspecialists are usually not shy about dropping knowledge if you ask for it); it may also help prevent future un-needed consults which they appreciate

Hope this helps.

Best preparation sources for step 3:

UWorld

This is the absolutely most important resource for you to use. If you are going to do nothing else to prepare for Step 3, then this is what I would recommend.

UWorld

NBMEs

it will highlight your areas of weakness and point you towards the areas you should be spending the most time.

NBME

Review Books

Review books should be used as a way to supplement your knowledge, refresh yourself on topics that you may not have seen for several years, and to address material that you are struggling to learn through the question bank.

The recommended books are:

1. First Aid for Step 3
   
2. Master the Boards for Step 3
   
   

   CCS
   

   
   1- UWorld’s CCS Cases help you prepare and boost your confidence for the test day. 
   
   uworld ccs
   
   2- Mapping CCS: 2019, excellent preparation tool wide range of cases. The high yield non uworld cases can be find
   here
   
   2019 Mapping ccs
   
   3- Crush CCS cases: provides easy and short review.
   
   crush ccs
   
   

   Biostats and Abstract/ Pharm ads:
   

   
   UWord biostats: Good review, good price
   
   UWorld Biostats
   
   Biostats words for the boards: good book, and the best is to take a live tutor course. it will save your time:
   
   Biostats words for the boards
   
   USMLE STEP 3 Preparation Plan:
   
   1. Start early
   
   Different preparation times have been suggested, Depending on what you are doing, if you are in residency or not, at
   least 3-4 weeks of dedicated studying for the exam is needed.
   
   2- Q Banks:
   
   NBMEs can be used as a way of predicting your final score. Take an NBME at the very beginning of your Step 3 study
   period. Doing this can give you a baseline score, and will often make students much less nervous about the exam.
   
   2. Consider using tutor
   
   Live tutor can save a lot of your time reviewing your weak points whether they are ccs, biostats or pharmacology. that
   will allow a more focused approach to your studying.  
   
   3. Master Clinical Case Simulation (CCS) Questions
   
   CCS accounts for 25% of your final score, before going to the exam, make sure that you practice the cases and you
   understand the principles about the software
   
   4. Don’t underestimate Biostats, preventive medicine, Abstract/ pharm ads and pharmacology questions
   
   The exam had a significant number of biostats questions, more than prior steps. These topics are as important as
   internal medicine and pediatrics in the exam.

I don't know of any "popular science" books that would actually give you a head start in medical school.
For example, Oliver Sacks' books, especially Musicophilia are broadly neurological in topic and really interesting, but reading them won't actually give you any major advantage when it comes to your studies.

However, if you're determined to get that headstart, I'd recommend reading up on either anatomy or physiology.

For anatomy, I'd recommend the Thieme Atlas of Anatomy books, although I might be biased, since one of my professors co-authored them and therefore used them religiously.
The books aren't text books in the classical sense, so there is little explanation given, but the illustrations are arguably the best I've seen so far.
You might also want to check out the google body project, although I found it severely lacking in terms of features, you can't, for example, look up innervations or muscle insertion points. Or maybe those are available once you shell out for premium content, I haven't tried that.

For physiology, I found Boron/Boulpaep's Medical Physiology to be thorough, detailed and very easy to read and understand. So this might actually be the book you're looking for. Even with limited or no prior knowledge in physiology and minimal experience with science in general, you'll be practically guaranteed to gain a deep working knowledge of physiology, which is arguably the basis for medicine in general and will serve you well throughout your studies at medical school.

If you already feel confident in both anatomy and physiology, maybe because you've done both in your undergraduate studies, I can't recommend Harrison's Principles of Internal Medicine enough. Almost everything you'll ever need to know about medicine is contained in this book and it is generally pretty well written. If you'd actually have enough time in medical school to thoroughly read and digest this two-volumed beast of a textbook, med school would be less about cramming than it is today.

So maybe get a headstart on that one.

Edit: On the other hand, you might as well enjoy your time before medical school and keep the fire burning by shadowing a physician from time to time or watching the first couple of seasons of House. That'll be more fun.

No single resource will do. Find a few different ones that you like and stick to them. Memrise will help but only as a supplement, not on its own. It'd also be a good idea to find someone to talk to about the language and gradually in the language instead, as your Spanish gets better. Lucky for you there are a ton of us Spanish speakers in the world, and it's one of the most popular languages to study. A quick search on here or /r/Spanish will help you find the resources people like best.

Ideally you could also get a textbook like this (first ones I found on google, cannot recommend or not recommend) http://www.amazon.com/Spanish-Medical-Interview-Textbook-Clinically/dp/1416036490 or this http://www.amazon.com/Medical-Spanish-Fourth-Edition-Bongiovanni/dp/0071442006/ref=pd_cp_b_1 that will help you learn the medical vocab you'll actually need to know along with the language.

I would recommend it. You'll have to be stricter initially and maybe for years but then you should be able to have more stuff. Allergy specialist might not be much help with the MCAS either. But hopefully they will.

I recommend this author and this book is quite useful, if somewhat old. I accidentally stumbled on the histamine intolerance diet in this book - because I was basically already on the diet, just needed to eliminate tomatoes and vinegar. (Which is a nightmare initially but you'll feel better.)
Dealing with Food Allergies: A Practical Guide to Detecting Culprit Foods and Eating a Healthy, Enjoyable Diet There's a newer version "packaged" as a text book for nutritionists. I just bought it used but it's more expensive.

You're going to need to figure out what your body agrees with. Histamine is a bucket to fill. You don't want to overflow the bucket. I'd start by dropping alcohol, tomato, food with preservatives, 90% soda, and vinegar.

You also want to learn about the age of food and how histamine develops as food gets older. You probably don't want to eat cooked food that's older than 2-3 days, assuming it was stored properly. You might not want to go over 48 hours. (Some people will eat leftovers a month later and then don't understand when they get sick. Hopefully this doesn't describe you.)

Be careful of all the websites and recipes and, well, shit, out there. There's so much more now than a few years ago. When you Google histamine intolerance now there's even more to wade through. Joneja has a website and other books. She's a fantastic source.

A more in depth book about MCAS by Afrin came out last year.

THIS is a fantastic academic journal article about histamine. I've seen it cited multiple times. It has a few tables/graphs that are super interesting.

Remember, your first and best sources are doctors and people with licenses. People who are sharing their experiences are great too but they might be very wrong and who knows how your body is different from theirs. You have to learn to understand what your body says is good or bad and some days that varies.

oh! almost forget. You might want to avoid NSAIDs if you don't already. Depends, on you, of course.

edit: I am not actually "officially" diagnosed but I clearly have fucked up mast cells and a fucked up immune system.

AP: (um, we have anatomic and clinical pathology divided in the USA)

Can't recommend Molavi enough. I think the best thing to read after Molavi is to read it a second time.

The real question is, one you've read that, what to read next. I agree with u/frogamazog, a big book like Rosai would be helpful. I always liked Fletcher's histopathology of tumors but I can't tell you it's superior to the alternatives.

But what I was after, and didn't always find, was a book that WASN'T comprehensive, that was readable by someone in their first 2 years. I found the biopsy interpretation series to be helpful as a first and second year as they were pretty readable, and...I was quite bad at pathology. Show me a low power image when I was a first year, I didn't know what I was supposed to see. The 20x and 40x photos sorta forced me to look in the right places.

My short list, which should be debated; I mean, maybe I just suck:

-lung: biopsy interpretation of the lung. for non neoplastic, new katzenstein

-liver: biopsy interpretation, mike torbenson's version is great

-derm, elston and ferringer. for non neoplastic, this one

-gi I'll go biopsy interpretation again before the tome that is odze

-thyroid: I actually don't know what's best here and would appreciate advice as any diagnostic skills I had here are rapidly being lost

-head n neck: biopsy interpretation aerodigestive was fun.

-heme: whew. I don't know a good starter book. Thoughts? Once WHO 2016 2017 update drops I'd be tempted to tell people to just start there. Jaffe's book is pretty readable but it gets dense.

-neuro: prayson's is pretty readable. There's an old smears book that's good for smears.

eyes: if you're gonna write an intro book on a niche field, here's the template

-BST: khurana's essentials in bone and soft tissue pathology. not too heavy.

To be honest I've not come across any truly "must have" emergency CT books. The "Emergency Radiology: The Requisites" book is something I've personally used - it's ok but I don't think many of my colleagues use it, and I've used it far less than I thought I would. Not as many pictures as I would have liked - it's a text book rather than a practical book, and it doesn't show enough different examples to be truly useful.

In terms of other books - what uses do you mean? As in do you want books to study for exams, practical books to get better at CT etc, essential reference books or books to have to hand during on-call/during reporting acute radiology?

Also a medical student, albeit a Spanish major in undergrad who has studied in Spain and Mexico. Wholeheartedly agree with the above comment. As long as you know your limits, you can be a vital patient asset for more simple needs when an interpreter isn't available. I think basic things such as understanding how to use the imperative to tell the patient what you would like them to do in preparation for the MRI could be a huge help for your team. I was a part of an advanced Spanish language program run by native speaking doctors during my preclinical years, and we used this book. Really, I think you could probably get by using a quality online dictionary to learn directions, commands, and anatomy, but your patients will definitely appreciate you making the attempt. Just MAKE SURE to know your limits, and if the situation calls for it, call in an interpreter to prevent a serious medical error from occurring. There are lots of medical professionals who are not fluent, but have a basic medical vocabulary that serves to help, not hurt, their patient care.

I have quite a few suggestions.

Specifically for nurses:

1. Schaum's Outline of Emergency Nursing: 242 Review Questions - Not my favorite one, but it serves as an ok reference.
   
   
2. Emergency Nursing Made Incredibly Easy - Love this one.
   
   
3. Saunders Nursing Survival Guide: Critical Care & Emergency Nursing - I like this one because it touches ICU as well as ER nursing.
   
   The following books are more for med students and MD's but I believe as nurses we need to understand rationales behind what MD's do, so these are good references:
   
   
4. Case Files Emergency Medicine - Goes over a number of cases involving common complaints seen in the ER, assessment findings, treatments, etc for those cases. By far my favorite book in my ER Library.
   
   
5. Emergency Medicine Secrets - doesn't have case studies like the book above, but goes more in detail about common and uncommon complaints seen in the ER.
   
   Miscellaneous books:
   
   
6. Rapid Interpretation of EKG's - as an ER nurse you'll need to constantly interpret the EKG of patients that are on the cardiac monitor to bring any changes to the attention of the MD. It really helps if you can identify those rhythms and this book is really easy to understand.
   
   Also consider subscribing to some journals. I'm subscribed to a few of them.
   
   
7. The Journal of Emergency Nursing
   
   
8. Nursing2016 Critical Care
   
   
9. Nursing2016
   
   I'm an ER medicine nerd, so I love reading this stuff but by no means do you need to have all these books. I just enjoy learning as much as I can about EM.

Hey dude, don’t feel bad! I think the physical exam is a lot more challenging than everyone lets on, especially when you are crunched for time, and knowing when it is actually helpful can be crazy challenging (e.g. is looking for an S4 gallop really going to change my management of this guy?).

I think the book you were trying to reference is McGee’s Evidence Based Physical Diagnosis. That book really helped me with knowing when a physical exam maneuver will help make a specific diagnosis or just waste my time. Pictures aren’t as great as Bates, but unlike Bates, McGee gives the evidence, sensitivities, and specificities whereas Bates more expects you to take their word for it.

As an intern, I for sure suck at the physical exam, but I just try and carve out time to practice things that might help or are important to document, and I’ve noticed I’m starting to get better, especially with those fricken’ dad-gummed pedal pulses (and of course the people you need to feel them on are BMI > 35). You’ll get better at it man, a lot of helpful advice on this thread, hope the link is helpful!

I have a few that I still use after two years in the Emergency Department:

Books

• Sheehy's Manual of Emergency Nursing Care This is by far the best resource I have.
  
  
• Rapid Interpretation of EKGs You will be interpreting EKG's to notify emergency docs if there is a rhythm that they need to be made aware of ASAP (i.e., STEMI, new-onset a-fib with rapid ventricular response, torsades, v-fib, SVT, etc...)
  
  Journals
  
  
• Journal of Emergency Nursing - some of the articles are fluff (i.e., impact on nurses of something in an obscure Chinese hospital), but a lot of them are medical/clinical in nature and very interesting.
  
  Blogs/Podcasts
  
  
• EMCrit - probably the best EM blog/podcast out there
  
  
• Life In The Fast Lane if we are ranking, this is tied for the number one spot of best EM blogs/podcasts
  
  
• The Skeptic's Guide to EM
  
  
• NurseEM not updated very frequently
  
  
• FOAMCast Free Open Access in Medicine - deals mostly with EM
  
  
• R.E.B.E.L Cast
  
  
• ER Cast
  
  
• Emergency Medicine Cases
  
  Subreddits
  
  
• /r/emergencymedicine
  
  
• /r/emcrit
  
  
• /r/medicine
  
  
• /r/neurology
  
  
• /r/cardiology

That's a good mneumonic but can trip you up if you totally blank out on one of the categories.

Symptom to Diagnosis is a good one to helps start off with.
www.amazon.com/gp/product/0071803440/

and there's the Diagnosaurus on Google Play/iTunes and on accessmedicine but doesn't fully categorize the broad issue complaint into subcategories like VITAMIN C.


I've been always up to seeking a better book that actually has them organized in that mnemonic-like fashion. Anyone come across one to recommend?

Best book on the market in my opinion is Rapid Interpretation of EKGs. Its been in print for decades, and its definitely held up over time as the best EKG books out there. It covers everything you need to know to have a solid understanding of the fundamentals of EKGs, and it does so in a way thats easy to understand.

The author is a convicted felon and child pornographer. But don't worry too much about that, its still a great book.

I have two, both I got for less than $10 each, used, off Amazon.

Here's the first one I purchased.

Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care, 9th Edition, Betty J. Ackle

https://www.amazon.com/gp/product/0323071503/ref=oh_aui_detailpage_o08_s00?ie=UTF8&psc=1

It's OK.

Here's the second one I purchased.

Clinical Companion to Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 8th Edition, Lewis

https://www.amazon.com/gp/product/0323066623/ref=oh_aui_detailpage_o04_s00?ie=UTF8&psc=1

Like this one a whole lot more. It's more ... how should I put this?

It gets to the point fast, and uses concise language. It's a small book, which is disconcerting at first, but when you realize how loaded it is with information, you're kind of amazed.

To be perfectly honest with you, clinical is my worst class. I'm fine with patients, have great bedside manner, and have zero issues following a nurse around and helping her all day long. It's when I get home and have to write up my clinical portfolio that I feel like screaming and setting my textbooks on fire. :D

I think Learn Rhythm adult is a good way to get started, but certainly pick up an introduction to EKG type book. People love Dale Dubin's EKG book (albeit he has a pretty sketchy background...) so you'll find a lot of people referring it.

If I recall though the Learn: Rhythm Adult course only covers 3-lead EKGs, and for a tech position you do want to learn a bit about 12 leads. The Physio Control 12 Lead made Easy program was fairly decent if I remember correctly.

I didn't downvote you and you weren't being offensive at all. This sub has a strong preference against over-using ketostix. I will explain why.

Ketostix are a cheap and relatively accurate way to measure the levels of acetoacetate in urine, one of the three ketone bodies, the other two ketone bodies being acetone and beta-hydroxyburic acid. The stix are very specific and very reliable.

A comparative study of Qualitative tests for ketones in Urine and Serum, Free et al, Clinical Chemistry Vol. 4 Issue 4, 1958
http://www.clinchem.org/content/4/4/323.full.pdf

This is worth repeating, because many people miss it. Ketostix can tell you the levels of acetoacetate in your urine. If you test positive, it does not mean you are in ketosis - it means that this test has detected acetoatate in your urine. If you test negative it does not mean you are not in ketosis - it means that this test can not detect acetoacetate in your urine.

Inferring that purple on the ketostix means "I am in ketosis" and no purple means "I am not in ketosis" is utterly false. All you know is that this test has shown or failed to show acetoacetate in your urine. You need to know more about the ketone bodies, and about the test, to infer meaning from the ketostix measurement.

The stix only measure the concentration of acetoacetate - drink more water and the ketones become diluted. A very common feature of the ketogenic diet recommendations are for dieters to drink much water, and to take electrolytes in solution. It is my personal experience that thirst rises significantly on a KD, and with it my water consumption. Correspondingly, I pee a lot more now - and that pee is dilute. A reason for many false-negative tests is likely to be due to the diluted nature of a ketogenic dieter's pee.

In principle, the ketostix work because they have segments of sodium nitroprusside - also known as nitroferricyanide. Nitroprusside reacts with acetoacetic acid to turn the segments a shade of colour at a precisely measured duration. Some of the fancier blood measuring strips also include sodium biphosphate as an acid buffer.

• The stix must be measured at a precise point in time (15seconds), leave them longer and they will always get darker.
  
  
• The stix are not sensitive to acetoacetate concentrations less than 50mg/litre.
  
  
• The stix do not react (much) to acetone, one of the three ketone bodies.
  
  
• The stix do not react at all to beta-hydroxyburic acid. This is the major cause of a false-negative reading.
  
  It is not just acetoacetic acid which turns the stix purple. Captopril, aspirin, methyldopa, mesna, acetylcsteine, levodopa, methyldopa, phenazopyridine and probably other drugs can also trigger a false-positive ketostix reading.
  
  > Basic Skills in Interpreting Laboratory Data – 2013
  by Mary Lee PharmD BCPS FCCP (Editor), http://www.amazon.com/dp/1585283436/
  
  The ketostix are not even very good at diagnosing diabetic ketoacidosis - their designed purpose. The levels of acetoacetic acid in urine can be many times higher than the levels seen in blood. As ketoacidosis subsides, beta-hydroxyburic acid degrades into acetoacetic acid - giving a stronger reading on the stix and a false indication of worsening ketoacidosis.
  
  Recent advances in the monitoring and management of diabetic ketoacidosis, T.M. Wallace, D.R. Matthews DOI: http://dx.doi.org/10.1093/qjmed/hch132
  http://qjmed.oxfordjournals.org/content/97/12/773.2
  
  The ADA says:
  
  > RECOMMENDATION: BLOOD KETONE DETERMINATIONS THAT RELY ON THE NITROPRUSSIDE REACTION SHOULD BE USED ONLY AS AN ADJUNCT TO DIAGNOSE DKA AND SHOULD NOT BE USED TO MONITOR DKA TREATMENT.
  
  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114322/#B187
  
  False positives can be seen if the urine is very acidic - after eating lots of vinegar for example. Or if ketones are being produced by intestinal bacteria.
  
  The ketostix degrade on exposure to air - they age badly. They can give false negative readings simply because they have stopped working.
  
  Now, back to nutritional ketosis, the goal of a ketogenic diet. In nutritional ketosis - at least after the initial few days and after a period of keto-adaptation, the majority of ketones produced and cleared are beta-hydroxyburic acid.
  
  Ketone body kinetics in humans: the effects of insulin-dependent diabetes, obesity, and starvation.
  http://www.jlr.org/content/25/11/1184.long
  
  There is some indication to suggest that ketotic athletes utilize 100% of free ketones, effectively leaving none for renal clearance:
  
  J Appl Physiol Respir Environ Exerc Physiol. 1978 Jan;44(1):5-11.
  Changes induced by exercise in rates of turnover and oxidation of ketone bodies in fasting man.
  http://www.ncbi.nlm.nih.gov/pubmed/627499
  
  Acute nutritional ketosis: implications for exercise performance and metabolism.
  Cox PJ1, Clarke K2.
  http://www.ncbi.nlm.nih.gov/pubmed/25379174
  
  HTH
  
  [edit] speling [sic]
  [edit 2]
  
  Hmm this came off a bit more strongly than I intended. The ketostix themselves are not a bad tool. They are just often used inappropriately.
  
  If you know their limitations, and if you are able to mix a number of factors into your reading of the stix beyond just the colour produced (level of hydration, diet over the preceding 12 hours, your own level of keto adaptation etc), then as the OP said it is entirely possible to reliably get value out of them.
  
  Most new keto dieters won't have the expertise necessary though, and so the recommendation to only use them in the beginning, once or twice, and then go back to concentrating on what is being eaten is really great advice - for most people most of the time.

I have this book. Definitely recommend. It doesn't get all the way down to the detailed physiology, but it does address basic pathophys in a way that should help you identify what you know or don't know.

If you really want to get into nitty gritty details, I'd recommend one of ~the~ physiology texts, like Boron & Boulpaep or something, but not for reading straight through. Just as a reference to look up that stuff you realized you didn't know.

We tend to use MacLeod's Clinical Examination here in Scotland and it is pretty great! Good detail, nice simple steps and explains what findings might mean, and it has an online resource too. There's a new edition coming out in June 2013 though so if you want the latest edition I'd hang fire or pre-order it.

I have the perfect book for you my friend.

The Patient History: Evidence-Based Approach (Tierney, The Patient History)

https://www.amazon.com/Patient-History-Evidence-Based-Approach-Tierney/dp/0071624945/ref=sr_1_1?ie=UTF8&qid=1465792447&sr=8-1&keywords=the+patient+history

It has flowcharts for many common presenting symptoms, including even super broad ones such as "fever" or "headache." Abnormal vaginal bleeding flowchart is on page 512, jaundice is on page 382.

Rapid interpretation of EKG's by Dr. Dale Dubin is excellent. Easy read and a great quick reference. Essentially a dummie's guide to EKG. I took a semester long class in EKG in college and am going through it again in paramedic school. This book is what made it click for me.

http://www.amazon.com/Rapid-Interpretation-EKGs-Sixth-Edition/dp/0912912065/ref=sr_1_sc_1?ie=UTF8&qid=1406594316&sr=8-1-spell&keywords=rapid+interptetation+of+ekg

the resource i always give my students (seems to be well received) is a facebook page called "12 lead ECG i've got the rhythm" run by ambulance personnel in england. 43 thousand people follow the page, all involved in medicine in some way. from interventional cardiologists, ER techs, electrophysiologists, paramedics/EMT's, ER consultants.. etc. people send anonymised ECG's from their patients and everyone gives their interpretation and reasoning. you can read and learn about different methods of interpretation and learn the lingo at the same time. it's essentially a massive catalogue of case studies that evolves every single day. if you do a couple of case studies a day, within a year or two your skills will have advanced considerably.

​

this book is also quite good.. it's what I used when i was in university: https://www.amazon.co.uk/ECG-Interpretation-Made-Incredibly-Easy/dp/1608312895

​

this website is also useful: https://litfl.com/ecg-library/

​

all the best mate

I've got two sites...

The best site to tell you what criteria you need for each rhythm is probably ECGpedia.

The next site I would recommend is really just a compilation of all the best ECG websites on the internet...Life in the Fast Lane ECG references

Also, some may disagree, but I think Rapid Interpretation of ECGs by Dale Dubin is the perfect book to start with.

[This book has nursing diagnoses, and interventions listed. The best part is that every intervention listed has a citation to a reference, so you can just plug in the "rationales" in your care plan.] (http://www.amazon.com/Nursing-Diagnosis-Handbook-Evidence-Based-Planning/dp/0323071503/ref=sr_1_7?ie=UTF8&qid=1319717408&sr=8-7.) My program makes a huge deal about "evidence based practice" so this book was a life send!

I really liked this book. I found the reading to be much more easier and enjoyable than a textbook...

Also I'll give a second vote to the Skillstat website posted by /u/JemLover

https://www.amazon.com/Rapid-Interpretation-EKGs-Sixth-Dubin/dp/0912912065 this book is amazing and explains it to you like you’re 5 years old. Lol

ECGs Made incredibly easy

Personally, I thought most of the books in this series were helpful. Good luck!

2 other great ECG books

ECG Interpretation Made Incredibly Easy!

http://www.amazon.com/Interpretation-Made-Incredibly-Easy-Series/dp/1608312895/ref=sr_1_2?ie=UTF8&qid=1377718462&sr=8-2&keywords=ecg+made+easy

12-Lead ECG: The Art of Interpretation

http://www.amazon.com/gp/product/0763712841/ref=oh_details_o07_s00_i00?ie=UTF8&psc=1

This is all you'll ever need. Macleod's Clinical Examination



You can also find the videos here

Good luck :)

Rapid Interpretation of EKG's, Sixth Edition https://www.amazon.com/dp/0912912065/ref=cm_sw_r_cp_apa_ED5MAbCN0H9CD

Recommended to me by an amazing seasoned ER nurse. Very easy to follow.

Hi carpevash.
Here is what I did.
I got the best rated book on amazon, studied for 2 days, passed the exam and returned the book lol.
https://www.amazon.com/gp/product/1610727991/ref=oh_aui_search_detailpage?ie=UTF8&psc=1

This book is pretty helpful, and I like it in particular because it basically does a "physiology pertaining to EKG's for dummies".

And yes, I know that Dubin turned out to be a sex offender and a creep, but the book is still good.

The Dubin book is the best! My copy is orange and it'll tell you everything you need to know about EKGs for tests :)

http://www.amazon.com/Rapid-Interpretation-EKGs-Sixth-Edition/dp/0912912065

Bates!

edit: amazon link: http://www.amazon.com/Bates-Guide-Physical-Examination-History-Taking/dp/1609137620

edit 2: http://meded.ucsd.edu/clinicalmed/history.htm is a great resource as well!

I'm not all the way through it but Rapid Interpretation of EKGs is AMAZING

Edit: hopefully I can answer some very basically:
Overall, remember you aren't measuring the conducting fibers with EKG, you are measuring the electrical activity of the myocytes. I think this may be a major sticking point for you - causing some confusion.

1. IV septum is depolarized from Left to Right as the RBB does not have terminal fibers (in the septum) - this leads to a sometimes present Q wave. You can't look at it as thinking of direction of conducting fibers, you have to think of how the muscle conductance changes. Assume the outer ventricle is a single muscle mass and depolarizes simultaneously. This will cause a concentric depol/repol not so much frontal.
   
   
2. not so sure about the why of opposite depol/repol something to do with the electrolyte balance and channels...
   
   There is good discussion (I had a lot of same issues you are having), but as an aside I REALLY recommend you take a look Dubin's Rapid Interpretation (I may have a pdf if you don't have access). My EKG lectures made no sense but I read through the relevant chapter there and felt like I everything made so much more intuitive sense.
   
   http://www.amazon.com/Rapid-Interpretation-EKGs-Sixth-Dubin/dp/0912912065/ref=sr_1_1?ie=UTF8&qid=1417975470&sr=8-1&keywords=dubin+rapid+interpretation+of+ekg

Go read the very excellent book evidence based physical.

http://www.amazon.com/Evidence-Based-Physical-Diagnosis-Expert-Consult/dp/1437722075

So much good stuff in there. I heard there is a PDF copy floating around the internet, should you willing to be a swarthy medical pirate.

I used Thomas Garcia's 12-Lead ECG: The Art of Interpretation. It goes above and beyond what you are required to know into stuff that is useful to know. It also breaks it down and gives tons of real world examples. This is how I learned EKGs. It might be better to start with something simpler, like Dale Dubin's Rapid Interpretation of EKG's, but I would make sure you know more than the simplistic version presented there.

Rapid Interpretation of EKG's

This is what we use in medical school and it is a great, simple resource. Wish I had used it back in my EMT days.

My Mom is taking this test in a month or so and she's really overwhelmed as to what she needs to focus on. She's worked as a tech for 15+ years in the same pharmacy and there is a new law that requires all techs be certified. Her employer isn't paying for any of their techs to become certified, so she doesn't want to mess up and have to take the test a bunch of times; she also graduated college in 1980 so it's been some times since she's done standardized testing.

She doesn't have the internet at home, so she did get this PTCB math test book as well as this study guide. Should I tell her to mainly focus on the math since she'll have a general idea of most of the other stuff (since she's working with it daily)? She's just kind of wondering what to expect. Thanks for your input!

http://www.amazon.com/Rapid-Interpretation-EKGs-Sixth-Edition/dp/0912912065

12 years after academy and I still read mine from time to time.

Also, have confidence. =)

I just finished this book for my IM rotation. Its a good, quick read, and hits all the points you need to impress your residents and attendings!

Dale Dubin wrote the definitive EKG book before going to prison for child pornography and cocaine possession. It's a REALLY good book, but feel free to buy it used!

Rapid Interpretation of EKG's, Sixth Edition https://www.amazon.com/dp/0912912065/ref=cm_sw_r_other_apa_JbnFxbTFMMBZJ

Maybe something like Symptoms to Diagnosis. It will help you build a differential based off the most common symptoms and diseases. I don't think it's meant to be used at all for Shelfs or general IM knowledge, just learning how to build a solid differential at the M3 level. Check to see if your library has online access through AccessMedicine.

yes they are. That's why I'm pretty desperate to find a way to lock them into my memory. Here you go. Amazon UK for your convenience.

http://www.amazon.co.uk/Macleods-Clinical-Diagnosis-Alan-MBChB/dp/0702035432/ref=sr_1_1?ie=UTF8&qid=1394311545&sr=8-1&keywords=macleod+clinical+diagnosis

http://www.amazon.co.uk/The-Patient-History-Evidence-Based-Approach/dp/0071624945/ref=sr_ob_1?ie=UTF8&qid=1394311514&sr=8-1

Rapid EKG Interpretation. Easy read and it will help you so much. It's got pictures in every page so it's perfect for us slow people.
Rapid Interpretation of EKG's, Sixth Edition https://www.amazon.com/dp/0912912065/ref=cm_sw_r_awd_IO7LwbFARMW0Z

Just wanted to reply with some links to see if these are the books are referring to.


I found both a standard text and pocket edition of Physical exam techniques by Bates. Is there a significant difference between the two besides size and perhaps less detail in the pocket edition?

http://www.amazon.com/Bates-Guide-Physical-Examination-History-Taking/dp/1609137620/ref=sr_1_fkmr2_1?ie=UTF8&qid=1427548257&sr=8-1-fkmr2&keywords=physical+exam+techniques+Bates

http://www.amazon.com/Pocket-Physical-Examination-History-Taking/dp/1451173229/ref=sr_1_fkmr2_2?ie=UTF8&qid=1427548199&sr=8-2-fkmr2&keywords=physical+exam+techniques+Bates

For clinical presentation, I found this on amazon.

http://www.amazon.com/Clinical-Encounter-Medical-Interview-Presentation/dp/0815113749/ref=sr_1_1?ie=UTF8&qid=1427547965&sr=8-1&keywords=clinical+presentation


For Diagnoses and treatment "The Merck Manual" I found this

http://www.amazon.com/Merck-Manual-Robert-S-Porter/dp/0911910190/ref=sr_1_1?ie=UTF8&qid=1427548053&sr=8-1&keywords=diagnoses+and+treatment+%28Current+2015%2C+Merck


Couldn't find anything on Harrison's anatomy on amazon. I currently have rapid interpretations of EKG, the latest addition as well.

Nancy Caroline's Emergency Care in the Streets is the "national registry" text book. And it's fairly decent. If you read it cover to cover and have half a brain you should pass national registry no problem.

Study whatever your state has published for drug protocols and treatment guidelines.

While I'm sure you saw a lot of EKG's at the hospital you worked at you still need to read Dubin's Rapid Interpretation and should probably get a practice book like Jane Huff's ECG Workout If you actually faithfully do Jane Huffs book cover to cover there is virtually no way you will fail statics or dynamics. And if you faithfully read Dubin's, including all the silly things he makes you do, you'll come out having a good knowledge of EKGs.

Dubin's is hands down the best introductory book on EKGs.

http://www.amazon.com/Rapid-Interpretation-EKGs-Sixth-Edition/dp/0912912065

Rapid Interpretation of EKG's by Dr. Dale Dubin. The classic, definitive textbook for understanding EKG's. It's amazingly simple, with loads of pictures and easy to understand explanations regarding cardiac issues. It is not the most detailed text around, but it is something that you could read in a weekend and walk away knowing much more than you did previously. Highly recommended to EMT's who want some sort of understanding of how to interpret 12 leads.

I think this book is really excellent and I use it often. I was a lab tech prior to PA school.

Clinician's Guide to Laboratory Medicine: Pocket https://www.amazon.com/dp/0972556184/ref=cm_sw_r_cp_api_snRXAbWMAVP27

My only advice would be to work the road as a basic to see what it's like. I worked the road for a little while (wish I woulda waited longer) but when you start learning everything in medic school everything seems to come together from what you saw on the read and what you read in class. But definitely

http://www.amazon.com/gp/aw/d/0912912065/ref=mp_s_a_1_1?qid=1397575975&sr=1-1&pi=SY200_QL40

Not sure how to link it differently on mobile but this is a great book. You spend a lot of time on cardiology.

Link to amazon. you can buy used for for like $70.

https://www.amazon.com/Bates-Guide-Physical-Examination-History-Taking/dp/1609137620/ref=sr_1_1?ie=UTF8&qid=1480534198&sr=8-1&keywords=bates+medical+physical+assessment+book

18 months ago I completed a B to P class through Good Fellowship in West Chester. Between class and clinicals it required most of your time, but worth it in the end. PM me if you want to know more. Read through Dubin's Rapid Interpretation Book it helped immensely.

https://www.amazon.com/Evidence-Based-Physical-Diagnosis-Steven-McGee/dp/1437722075

If you can find a copy, this book is interesting. There is a JAMA one too.

Get yourself this book, too. It's helped me a great deal but I still get MDs to interpret EKGs for me.

I recommend Rapid Interpretation of EKG's 6th Edition by Dale Dublin, MD. I bought in when I was in paramedic school and still use it today.

https://www.amazon.com/Rapid-Interpretation-EKGs-Sixth-Dubin/dp/0912912065


Worth every penny.

http://www.amazon.com/Rapid-Interpretation-EKGs-Sixth-Edition/dp/0912912065

Can't go wrong with this book.

A "BART" (Basic Arrhythmia Recognition Training) course is not common in EMS fields(at least in my area). I've seen a couple in-hospital so "transfer staff" can move patients between floors without escorts.

In EMS its kinda 'black and white' either you 'need to know' or 'don't need to know' ECG rhythms.

As for the class, it's an entry level class so they shouldn't require any prep but check out "life in the fast lane" link below if you want to explore more.

https://lifeinthefastlane.com/ecg-library/

If you wanna go real deep, check out the Dale Dubin book.

https://www.amazon.com/Rapid-Interpretation-EKGs-Sixth-Dubin/dp/0912912065

If I may ask, whats your reason for taking this class?

Dale Dubin Rapid Interpretation of EKGs

Life In The Fast Lane

Dr. Smith's ECG Blog

Rapid Interpretation of EKG's: Dr. Dubin's Classic, Simplified Methodology for Understanding EKG's https://www.amazon.ca/dp/0912912065/ref=cm_sw_r_cp_api_i_ncd6Cb75KA2DE

To start off with, I'd suggest

Dale Dubin's Rapid Interpreation of EKGs

And this article on theEmtSpot

Dubin's Rapid Interpretation of EKGs

This book is the gold standard : Rapid Interpretation of EKG's, Sixth Edition https://www.amazon.com/dp/0912912065/ref=cm_sw_r_cp_apa_TMO6xbXE9W8MB

For simple rhythms just search YouTube. There are a lot of videos that go through the basics.

https://www.amazon.com/Rapid-Interpretation-EKGs-Sixth-Dubin/dp/0912912065/ref=mp_s_a_1_3?keywords=ekg+interpretation+book&qid=1568959702&s=gateway&sprefix=ekg+int&sr=8-3

https://www.amazon.com/Rapid-Interpretation-EKGs-Sixth-Dubin/dp/0912912065

This is the book I used the most.

3 lead or 12 lead?

If only 3 lead buy Rapid Interpretation of EKG's.
https://www.amazon.com/Rapid-Interpretation-EKGs-Sixth-Dubin/dp/0912912065

You be able to read a 3 lead within a day.

Rapid Interpretation of EKG's, Sixth Edition

Edit: Formatting

If you really have to study, learn how to interpret EKGs. http://www.amazon.com/Rapid-Interpretation-EKGs-Sixth-Dubin/dp/0912912065

ED radiology - the requisites

E copy is available on Elsevier's ClinicalKey website if you have institutional access.

This is the classic introduction to EKG interpretation:

https://www.amazon.com/Rapid-Interpretation-EKGs-Sixth-Dubin/dp/0912912065/

Will edit more resources in a bit..


Here's some of the EKG resources I used in PCP school:

Life in the Fast Lane

Dr. Smith's EKG Blog

Dale Dubin's Rapid Interpretation of EKG's

Dr. Mattu ECG Weekly

Dr. Mattu YouTube Channel (not updated anymore but has 200+ vids)

https://www.amazon.com/Rapid-Interpretation-EKGs-Sixth-Dubin/dp/0912912065/ref=mp_s_a_1_1/140-8321072-0767464?ie=UTF8&qid=1524925860&sr=8-1&pi=AC_SX236_SY340_QL65&keywords=dubins+ekg+book&dpPl=1&dpID=51dYWaQomOL&ref=plSrch

Dubin

https://www.amazon.com/Rapid-Interpretation-EKGs-Sixth-Dubin/dp/0912912065

Read this before/during shadowing (you can find a PDF if you look hard enough). http://www.amazon.com/Rapid-Interpretation-EKGs-Sixth-Edition/dp/0912912065. None of it may make any sense but at least you may get some sort of idea of what is going on while shadowing a doc.

Go hang out in /r/premed. Avoid SDN forums.

High school grades/scores do not matter for medical school. Shadowing/volunteer work in high school does not count for medical school applications. Major in something you enjoy in college. Don't be a typical pre-med bio major. Be open minded and don't set your heart on cardiology (hah) as it will likely change when you do 3rd and 4th year medical school rotations.

I’m not sure if you’ve come across this text yet but Rapid Review of EKGs was crucial when I was a medical student. You can read it in one sitting and feel so comfortable reading EKGs.

This is a full post that I "stole" from another very knowledgeable user. Lots of information and a few sources in here.

Ketostix are a cheap and relatively accurate way to measure the levels of acetoacetate in urine, one of the three ketone bodies, the other two ketone bodies being acetone and beta-hydroxyburic acid. The stix are very specific and very reliable.

A comparative study of Qualitative tests for ketones in Urine and Serum, Free et al, Clinical Chemistry Vol. 4 Issue 4, 1958
http://www.clinchem.org/content/4/4/323.full.pdf

This is worth repeating, because many people miss it. Ketostix can tell you the levels of acetoacetate in your urine. If you test positive, it does not mean you are in ketosis - it means that this test has detected acetoatate in your urine. If you test negative it does not mean you are not in ketosis - it means that this test can not detect acetoacetate in your urine.

Inferring that purple on the ketostix means "I am in ketosis" and no purple means "I am not in ketosis" is utterly false. All you know is that this test has shown or failed to show acetoacetate in your urine. You need to know more about the ketone bodies, and about the test, to infer meaning from the ketostix measurement.
The stix only measure the concentration of acetoacetate - drink more water and the ketones become diluted. A very common feature of the ketogenic diet recommendations are for dieters to drink much water, and to take electrolytes in solution. It is my personal experience that thirst rises significantly on a KD, and with it my water consumption.

Correspondingly, I pee a lot more now - and that pee is dilute. A reason for many false-negative tests is likely to be due to the diluted nature of a ketogenic dieter's pee.

In principle, the ketostix work because they have segments of sodium nitroprusside - also known as nitroferricyanide. Nitroprusside reacts with acetoacetic acid to turn the segments a shade of colour at a precisely measured duration. Some of the fancier blood measuring strips also include sodium biphosphate as an acid buffer.
• The stix must be measured at a precise point in time (15seconds), leave them longer and they will always get darker.
• The stix are not sensitive to acetoacetate concentrations less than 50mg/litre.
• The stix do not react (much) to acetone, one of the three ketone bodies.
• The stix do not react at all to beta-hydroxyburic acid. This is the major cause of a false-negative reading.

It is not just acetoacetic acid which turns the stix purple. Captopril, aspirin, methyldopa, mesna, acetylcsteine, levodopa, methyldopa, phenazopyridine and probably other drugs can also trigger a false-positive ketostix reading.
Basic Skills in Interpreting Laboratory Data – 2013 by Mary Lee PharmD BCPS FCCP (Editor),http://www.amazon.com/dp/1585283436/

The ketostix are not even very good at diagnosing diabetic ketoacidosis - their designed purpose. The levels of acetoacetic acid in urine can be many times higher than the levels seen in blood. As ketoacidosis subsides, beta-hydroxyburic acid degrades into acetoacetic acid - giving a stronger reading on the stix and a false indication of worsening ketoacidosis.

Recent advances in the monitoring and management of diabetic ketoacidosis, T.M. Wallace, D.R. Matthews DOI:http://dx.doi.org/10.1093/qjmed/hch132
http://qjmed.oxfordjournals.org/content/97/12/773.2

The ADA says:
RECOMMENDATION: BLOOD KETONE DETERMINATIONS THAT RELY ON THE NITROPRUSSIDE REACTION SHOULD BE USED ONLY AS AN ADJUNCT TO DIAGNOSE DKA AND SHOULD NOT BE USED TO MONITOR DKA TREATMENT.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114322/#B187

False positives can be seen if the urine is very acidic - after eating lots of vinegar for example. Or if ketones are being produced by intestinal bacteria.

The ketostix degrade on exposure to air - they age badly. They can give false negative readings simply because they have stopped working.

Now, back to nutritional ketosis, the goal of a ketogenic diet. In nutritional ketosis - at least after the initial few days and after a period of keto-adaptation, the majority of ketones produced and cleared are beta-hydroxyburic acid.
Ketone body kinetics in humans: the effects of insulin-dependent diabetes, obesity, and starvation.http://www.jlr.org/content/25/11/1184.long

There is some indication to suggest that ketotic athletes utilize 100% of free ketones, effectively leaving none for renal clearance:

J Appl Physiol Respir Environ Exerc Physiol. 1978 Jan;44(1):5-11. Changes induced by exercise in rates of turnover and oxidation of ketone bodies in fasting man. http://www.ncbi.nlm.nih.gov/pubmed/627499
Acute nutritional ketosis: implications for exercise performance and metabolism. Cox PJ1, Clarke K2.http://www.ncbi.nlm.nih.gov/pubmed/25379174

Read ~1500 pages of ridiculously dense pathology material in two semesters while keeping up with the extra material from lecture. Then when you move onto 3rd year you can read ~4000 pages of Harrison's while doing rotations 8-12+ hours a day.

Undergrad is understanding 5-10 topics a week. Med school is understanding those same 5-10 topics in a single lecture x 8 lectures/day. Without exaggeration, we literally covered an entire semester of undergrad anatomy in our first week. Covered a year of biochem in 6 weeks at the same time with anatomy and other courses. The pace of material covered is not understandable until you get there.

btw if you still want to read textbooks, here you go:

http://www.amazon.com/Robbins-Cotran-Pathologic-Basis-Disease/dp/1416031219/ref=sr_1_1?ie=UTF8&qid=1373635912&sr=8-1&keywords=robbins+pathology

http://www.amazon.com/Harrisons-Principles-Internal-Medicine-Volumes/dp/007174889X/ref=sr_1_1?s=books&ie=UTF8&qid=1373635885&sr=1-1&keywords=harrison%27s+principles+of+internal+medicine

3rd Degree's are like my favorite. I'm a complete nerd. Some people collect silver spoons, shot glasses, stuffed animals: me, I collect rhythm strips and empty IV med vials.

So 3rd degree heart blocks are pretty interesting. You have irregular ones which are usually completely unstable: you stopped looking at the monitor because their BP and SpO2 are wack, it's time for ACLS.

But when you get used to stable 3rd degrees you start to notice something interesting. You start noticing a lot of regular intervals. You start seeing a lot of 2 regular rhythms put together to form something irregular.

So disclaimer here: you see a 3rd degree put on the pacer pads until a cardiologist tells you otherwise.

But if you notice that the QRS complexes have a regular interval and then the P waves have regular intervals. Well that's kind of neat. Because you start seeing those p waves and qrs complexes where you expect them. And you have no problem differentiating a P and a T.

T waves are cool and all. I mean they indicate something. But most of the time they just follow the qrs and a p pops in there where ever it feels like, it's almost musical really. Not a super big deal in 3rd degree. You see an R wave fall on a T; well that's different.

But enough about how cool or interesting it is. What's really going on here? Well a pace maker cell in a heart will fire unless it's inhibited. So lets say you have a higher pacer firing at it's faster programed speed up there in the atria but there is a block between that pacer and a lower one down below the bundle. The lower one doesn't get inhibited by the higher atrial pacer cell and vice versa. So basically you have 2 cells firing at two different speeds but at regular intervals independent of one another. They just don't know the other exists.

You know what? I'm not the guy you should be asking: BOOM you're now an expert.

As an edit I'd just like to mention something I've come across in the past few years. Sometimes you get these 3rd degrees that are almost stable but have periods of instability or long pauses. You're like wtf man you're supposed to be stable, the cardiologist is not coming in until, at the earliest, 6am, more like 8am. Stop making my transcutaneous pacer fire! I mean, does that feel good?!

So 3rd degree's are the product of some disease process right? What am I noticing with you? CAD and OSA maybe? You're having some long pauses with a drop in BP with a period of apnea? What can we do about this until you get your pacer surgery in the AM?