# Monitoring Mode vs Diagnostic Mode



## 18G (Feb 19, 2011)

I am curious as to the difference between the two modes. Obviously, I know there is a difference I am curious what it is and why. 

I've had a few patients that showed what appeared to be significant ST elevation in monitoring mode but then when 12-lead is performed ST segment is normal. What gives?


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## 8jimi8 (Feb 19, 2011)

Monitor mode is good for watching heart rate, and basic morphology.

Diagnostic is for more accurate interpretation and measurement.

In monitoring mode lead placement can be less strict e.g. limb leads on the torso.

Diagnostic quality tracings require accurate anatomical placement.  You can see why accuracy is so important when it comes to concepts like stemi alert.


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## TomB (Feb 19, 2011)

The low frequency / high pass filter needs to be set at 0.05 Hz to get accurate ST-segments.


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## 18G (Feb 19, 2011)

Im still confused on the two modes. Why does one show off the wall ST elevation and another show none at all? Why the variation?

Tom u mentioned something about a filter setting. I assume this is a service tech setting and not user setting?


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## usalsfyre (Feb 19, 2011)

18G said:


> Im still confused on the two modes. Why does one show off the wall ST elevation and another show none at all? Why the variation?
> 
> Tom u mentioned something about a filter setting. I assume this is a service tech setting and not user setting?



On the old LP10s the user could change it for a modified 9 lead, but I don't remember how...

The variance is due to the variation in the frequency of electricity that is making it through the filter.


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## TomB (Feb 19, 2011)

It's a function of how much bandwidth of the electrical signal you're monitoring. 

Monitor mode
1 - 30 Hz

Diagnostic mode

0.05 - 150 Hz  -or-
0.05 - 40 Hz

We use the latter setting for diagnostic mode because setting the high frequency / low pass filter at 40 Hz seems to help filter out 60 cycle (U.S. electrical) interference while maintaining accurate ST-segments.

Most modern 12-lead ECG monitors will automatically switch to diagnostic mode when you print a 12-lead ECG.

It must be said that often you can recognize an acute injury pattern even in monitor mode but it's true that on rare occasions monitor mode shows ST-elevation and diagnostic mode does not (or vice-versa).


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## TomB (Feb 19, 2011)

usalsfyre said:


> On the old LP10s the user could change it for a modified 9 lead, but I don't remember how...
> 
> The variance is due to the variation in the frequency of electricity that is making it through the filter.



On the old LP10 you could hold down the print button until it said DIAG on the screen and then you'd be in diagnostic mode.


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## 18G (Feb 20, 2011)

I had one of those rare occasions early this morning with a patient who had severe resp distress w/ pulmonary edema. Inferior leads showed significant ST elevation while the multiple pre-hospital and ED 12-leads did not.


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## mgr22 (Feb 20, 2011)

Just to build on other responses, monitor mode suppresses low and high frequencies. You get less artifact (high frequency), but your ST segments (low frequency) are not necessarily accurate. In fact, you might see, say, ST elevation in a monitor-mode tracing, and ST depression in a diagnostic tracing for the same patient.


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## Akulahawk (Feb 22, 2011)

TomB said:


> On the old LP10 you could hold down the print button until it said DIAG on the screen and then you'd be in diagnostic mode.


Yes. You hold the print button down for a few seconds and then it will print a strip in diagnostic mode. The visual display quality never changes. I believe that the diag strip will also say "diag" on it so that the person interpreting the strip at a later time will know it's a diagnostic quality strip. Also, the closest you can get to a 12 lead is a 9-lead, with 6 modified chest leads, not true V-leads. I used to like using MCL1 during transport if Lead II had too much motion artifact. 

Of course that was "back in the day" before 12-lead units were common, if not required. The LP-12 was a rare thing to see on an ambulance...


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## johnmedic (Mar 3, 2011)

Do newer Lifepacks have monitor vs diagnostic modes, LP12 & LP15's? Anyone know how to switch between em? I haven't heard of the different settings before.


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## EMTinNEPA (Mar 3, 2011)

Basically, the short answer is that monitoring mode focuses on an accurate count of QRS complexes to provide you a heart-rate.  Diagnostic mode focuses more on quality tracings and (especially) the ST segment.  As far as I know, the only way to get a diagnostic quality tracing is to do a 12-lead.


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## mgr22 (Mar 3, 2011)

johnmedic said:


> Do newer Lifepacks have monitor vs diagnostic modes, LP12 & LP15's? Anyone know how to switch between em? I haven't heard of the different settings before.



On the LP12, you press the Options button to get into print modes, then select Monitor or Diagnostic. The diagnostic setting applies to the printed strip only -- not to what you see on the screen.

I'm not sure if the LP15 works the same way.


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## MasterIntubator (Mar 3, 2011)

The LP15 works the same way as the 12.

Standard monitor strips = 1 - 30 Hz
Diagnostic monitor/12 lead = 0.05 - 40 Hz ( the LP interpretation is still based on 0.05 - 150Hz, you just see the 40Hz on print out )
Pediatric mode 12 lead = 0.05 - 150 Hz ( get this by selecting the age 15 or younger )

The first 2 frequencies are our EMS standard, and the diagnostic mode will show us everything we need without the added noise/interference.

The ultimate standard for diagnostic ECGs is the 0.05 - 150 Hz frequency, and is typically used in hospital because they don't have to worry about road noise, etc.

Why would we use the 0.05 - 150 Hz?  QRS amplitude diagnostics... for determining hypertrophy ( but really... very few of us do that in the EMS field ).  In pediatrics, the R wave is usually has a lower amplitude in the 40Hz mode due to the narrowed QRS.


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## MasterIntubator (Mar 3, 2011)

Ohh... you can set your monitoring mode by getting into LP setup, and setting your monitor settings.  Which requires a password ( default 0000 ), and most likely permission from whomever is in charge of that stuff.

p.s.   For those paddle heads... the paddles are 2.5 - 30 Hz ( the narrower the freqs.. the less noise... the less diagnostic quallity


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