• Check first for lead placement: AVR and AVL should be mirror images
• Limb leads: (a) check aVR for upside down P, QRS and T waves, (b) aVL and aVR should generally be mirror images.
• Chest leads: look for RS pattern in V1 – changing progressively to QR pattern in V6.

Reference: https://litfl.com/ecg-rule-of-fours/

EKG Basic Interpretation Video

• Flattening of T wave and appearance of U wave directly after
• V2 and V3 usually
• Can appear as prolonged QT due to U wave, treat similarly
• NOT ACS/Ischemia.
• “reverse wellens or Nikelkam twave”

Info from Amal Mattu EEM 2019: Hypokalemia: You thought you knew how to recognize it