the 100% directionless thread

[9D4]

Is this a hypothetical or is there a strip associated with this?

There's a strip. I'll snap a pic in a minute, eating dinner real quick. There was two, one with artifact, one without and I accidentally grabbed the one with artifact, so some looks like p waves, but they aren't there.
Edit: See if this works, never posted a pic, haha. Apologize beforehand for it being split and the shadow, my phone's camera sucks and it was blurry trying to take a whole shot, along with me being a sucky photographer. Wayyy too big, hang on.
18 YOM, resting rate of 55 BPM (says 66 on the strip, but 90% of the time it was at mid 50's). PA and 3 medics looked at it and none could see P waves on any besides lead 1.

 

[chaz90]

Another note, what would cause a P wave to only be visible in lead 1?

Axis of atrial depolarization. P waves are small anyway so fairly easy to hide/overlook, so a slightly atypical P axis can easily cause them to be visible in only a few leads. Check out the LifePak 12 lead interpretation box sometime. It gives values for P-QRS-T axes even though EMS typically only looks at the QRS (if any).

BTW, you'll see this alllll the time.

 

[9D4]

Axis of atrial depolarization. P waves are small anyway so fairly easy to hide/overlook, so a slightly atypical P axis can easily cause them to be visible in only a few leads. Check out the LifePak 12 lead interpretation box sometime. It gives values for P-QRS-T axes even though EMS typically only looks at the QRS (if any).

BTW, you'll see this alllll the time.

It was a LifePak 15. Axis is 29 degrees for the P wave, whole values for P- QRS- T are 29, 42, 48. PA mentioned that, then dismissed, saying that it was normal. Not sure what normal actually is, since he didn't say a value.
Edit: Just realized it sounded like I was dismissing your answer. I wasn't, I've just heard 2 different things now. Good to know that, I wasn't aware.
Only reason I'm interested is because this is off me, haha.

 

[Anjel]

Looks perfectly normal to me. It could be a lot of reasons, but like Chaz said, p waves are small and can get lost sometimes.

Also did you have your limb leads on your torso? Or your arms and legs. There shouldn't if been so much artifact under ideal conditions.

 

[9D4]

Looks perfectly normal to me. It could be a lot of reasons, but like Chaz said, p waves are small and can get lost sometimes.

Also did you have your limb leads on your torso? Or your arms and legs. There shouldn't if been so much artifact under ideal conditions.

On the actual limbs. Forearms on the frontal sides, median sides of the calves.

The artifact was because I was extremely cold and trying not to shiver. Wasn't working real well.

Like I said 2nd came out better, but I tossed that one on accident and kept this one thinking it was the other.
I'll try to remember to get a 3rd set up next class and not laugh during the print.

On to the actual part, though, if you saw that would the only thing that matters is that it is present in at least one?
Would that be for any wave form? Say you can only see a T wave in one lead, that's alright? That's a hypothetical situation, I'm just seeing if it applies to other situations.

 

[Anjel]

You got to look at the whole picture. I'm pretty sure I see P waves in AVL and AVR.

The QRS is narrow and regular. Looking at this I wouldn't suspect Junctional or anything like that.

 

[JPINFV]

Next stop on the interview trail will be Monroe, MI. Date left to be set.

 

[Anjel]

Next stop on the interview trail will be Monroe, MI. Date left to be set.

Woot woot. What the heck is in Monroe? Welcome to the Mitten!

 

[Akulahawk]

There's a strip. I'll snap a pic in a minute, eating dinner real quick. There was two, one with artifact, one without and I accidentally grabbed the one with artifact, so some looks like p waves, but they aren't there.
Edit: See if this works, never posted a pic, haha. Apologize beforehand for it being split and the shadow, my phone's camera sucks and it was blurry trying to take a whole shot, along with me being a sucky photographer. Wayyy too big, hang on.
Patient is 18 YOM, resting rate of 55 BPM (says 66 on the strip, but 90% of the time it was at mid 50's). PA and 3 medics looked at it and none could see P waves on any besides lead 1.

I see P-waves in more than just lead I. I saw them in Lead III, AVL, AVF, and most of the V leads. They're just really, really small. Those P waves really are there...

If all I had was Lead II or III, I'd have a REALLY hard time finding the P waves though.

 

[Anjel]

I see P-waves in more than just lead I. I saw them in Lead III, AVL, AVF, and most of the V leads. They're just really, really small. Those P waves really are there...

Oh I didn't see the second pic. Ya I can see them in the precordial leads as well.

 

[9D4]

You got to look at the whole picture. I'm pretty sure I see P waves in AVL and AVR.

The QRS is narrow and regular. Looking at this I wouldn't suspect Junctional or anything like that.

Thank you to both you and Chaz
We briefly talked it over when we saw it, but I didn't quite comprehend, so I figured I'd ask here.

It just spun me for a loop when I didn't see it in Lead 2, because we just started these not to long ago, as in today was our second class, and the lack of a P wave along with the rate of 55 made me not think Sinus rhythm.
It just confused me, but the whole topic does so far, ha.
Akula, once Angel pointed them out, I can make them out, I think. Like I said, just started this and I couldn't make it out.
Look like a bit of an ***, now, but hey... Least I wasn't the only one that couldn't make them out

 

[Akulahawk]

Thank you to both you and Chaz
We briefly talked it over when we saw it, but I didn't quite comprehend, so I figured I'd ask here.

It just spun me for a loop when I didn't see it in Lead 2, because we just started these not to long ago, as in today was our second class, and the lack of a P wave along with the rate of 55 made me not think Sinus rhythm.
It just confused me, but the whole topic does so far, ha.
Akula, once Angel pointed them out, I can make them out, I think. Like I said, just started this and I couldn't make it out.
Look like a bit of an ***, now, but hey... Least I wasn't the only one that couldn't make them out

Not to worry. It's only your 2nd class... You'll get a LOT better from here on out. Not to mention you've got a "good" 12-lead with some artifact (shivering) to refer to later...

 

[JPINFV]

Woot woot. What the heck is in Monroe? Welcome to the Mitten!

South of Detroit.

 

[Anjel]

South of Detroit.

I Know where Monroe is. About 45 minutes from me I believe. I just don't know of many things in Monroe.

 

[JPINFV]

I Know where Monroe is. About 45 minutes from me I believe. I just don't know of many things in Monroe.

Well... Mercy Memorial Hospital is there... and they just opened up an EM residency.

 

[Anjel]

Well... Mercy Memorial Hospital is there... and they just opened up an EM residency.

Hmm. Never heard of it lol but good luck!

 

[Handsome Robb]

Thank you to both you and Chaz
We briefly talked it over when we saw it, but I didn't quite comprehend, so I figured I'd ask here.

It just spun me for a loop when I didn't see it in Lead 2, because we just started these not to long ago, as in today was our second class, and the lack of a P wave along with the rate of 55 made me not think Sinus rhythm.
It just confused me, but the whole topic does so far, ha.
Akula, once Angel pointed them out, I can make them out, I think. Like I said, just started this and I couldn't make it out.
Look like a bit of an ***, now, but hey... Least I wasn't the only one that couldn't make them out

Definitely agree that there are P-waves there. Don't worry dude, you'll get better ECG interpretation just takes time and lots of practice. I think we did upwards of 1000 strips in school for homework. That's a combination of single and 12-leads.

Keep after it and don't hesitate to use us as a resource. This site and the people on it helped me immensely during school both with school and handling life with school and working. Especially if you work full time. We're always glad to help, just wont do your homework for ya

It's too bad the chat isn't as active as it used to be, we always used to have a lot of fun in there and I learned a ton. I finally got a charger for my computer so now that I'm back around I might have to start hanging out in there again if people are going to join me.

 

[Achilles]

I Know where Monroe is. About 45 minutes from me I believe. I just don't know of many things in Monroe.

only five minutes for me :lol:
Cabelas is in monroe

 

[Anjel]

only five minutes for me :lol:
Cabelas is in monroe

Dundee I thought? Or is it pretty much the same? A friend of mine and u are going there soon to gun shop.

 

[Achilles]

Dundee I thought? Or is it pretty much the same? A friend of mine and u are going there soon to gun shop.

It's the same