ALWAYS-AVAILABLE REFERENCE

read every ECG
in the same order.

Use this framework while learning, practising, or presenting a case. The sequence matters more than speed.

Check the tracing

Confirm patient, date, lead quality, speed (25 mm/s), and gain (10 mm/mV).

Estimate atrial and ventricular rates. For regular rhythms: 300 ÷ large boxes between R waves.

Decide regular or irregular. Then ask where the rhythm originates.

Check I and aVF. If I is positive and aVF negative, inspect II before calling left axis deviation.

Are P waves present, consistent, and followed by a QRS?

Measure from the start of P to the start of QRS. Normal: 120–200 ms.

Assess width, voltage, morphology, and R-wave progression. Normal width: under 120 ms.

Measure QT and consider a rate-corrected value.

Look systematically for elevation, depression, inversion, or unusual morphology.

Summarize rate, rhythm, axis, intervals, key abnormalities, and the clinical meaning.