# Portable 3 lead ecg



## jjdjld (May 10, 2013)

Hi, 

I'm not entirely certain if anyone can help. In the area I work I do a minimum of two patient declarations each shift. I prefer to hook up a 3 lead ECG to confirm this. 

Is anyone aware of a solution/application/cable that is capable of turning my IPAD or Iphone into a 3 lead ECG. I know there are similar products that achieve something similar but I haven't yet been able to find any that have the ability to use physical 3 Lead Electrodes (the ones I have found use strange straps or casings that have to be placed against the chest).

Any help would be appreciated. Thanks in advance.


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## medicdan (May 10, 2013)

While I guess they exist in theory, I don't know that I see the point. If I'm walking in to any call that could be a decleration I'm brining in anything I would need to work the code, and that includes a monitor/defib and a whole bunch of other crap (autopulse/lucas, drug box, boarding crap), and I don't particularly want to bring an ipad as well (sidenote: I'm trying to remember to try out a new aha app to document codes on my ipad...0

I'm not sure how you'd overcome the documentation problems, like no easily way to print strips, attach to a PCR, etc. 

I like the idea in theory, but I can think of better ways of using ipads and technology than for strips on death pronouncements. 

Am I missing something here?


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## chaz90 (May 10, 2013)

Where do you work that you do two DOAs every shift? Man, that'd get old real quick. In response to the original post though, why not just use the monitor?


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## Milla3P (May 10, 2013)

You say you "prefer" to put them on the monitor? What that means to me is that your protocols allow you to do a DOA without one, right?
Are you not comfortable just determining obvious signs of natural death? I'd think you would be an ace doing 4 to 10 a Week. 

Or are you using the asystole as your determining factor? If that's the case you should probably rethink your practices before your medical director does.


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## Handsome Robb (May 10, 2013)

Milla3P said:


> You say you "prefer" to put them on the monitor? What that means to me is that your protocols allow you to do a DOA without one, right?
> Are you not comfortable just determining obvious signs of natural death? I'd think you would be an ace doing 4 to 10 a Week.
> 
> Or are you using the asystole as your determining factor? If that's the case you should probably rethink your practices before your medical director does.



That was my question as well.

Chaz, I generally will have a working arrest or obvious death 2-4 times a week in a 4 day work week. Sometimes it slows down, sometimes it speeds up, just depends on my luck. 

Worked three arrests back to back to back a while ago. That was a :censored::censored::censored::censored:ty day.


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## chaz90 (May 10, 2013)

I worked two arrests back to back once, and that was already plenty of cleaning and restocking for me. Kinda demoralizing to barely get done with one, only to be nice and take a Delta level call from another unit that turns into a full code.


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## jjdjld (May 11, 2013)

*Reply*

Hi again, 

To answer a few questions that were asked....

We do have the ability to declare with or without asystole reading on an ECG. Given the amount of declarations I do on a shift (6 on the last) there are instances where the circumstances surrounding the incident necessitate the need for an ECG. Fact of the matter is that there are patients where you have doubts. At the same time there is no need for me to print out a strip in order to attach to our PRF (PCR). 

We routinely run calls where there are other EMT's on scene and they would like to declare, unfortunately our protocols do not allow for this and a higher qualified individual needs to be sent. So essentially, on receiving the call we are already certain it is a declaration. 

The idea behind having a smaller ECG unit is because many of my calls require me to walk up 18 flights of stairs while carrying a jump bag, drug bag, ECG, Oxygen bag (We work individually). And as mentioned a lot of the time I am 100% certain it is a declaration, and chances are the patient has been dead for several hours.


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## Handsome Robb (May 11, 2013)

I think we'd have to know more about how your system is designed and how your declaration protocol works to have any sort of informed response.

To answer your question, no I have not heard of a 3 lead attachment for a tablet, the Propaq monitors are tiny and light...that's the only thing close that I can think of.

I still don't understand why you need the asystole strip. If there's any question in your mind as far as obvious vs potentially viable I've always been taught and tend to agree with the thought process that you should work that patient. Again though, without knowing your protocol it's difficult to discuss. 

Random question cause I have to be that guy, what happens if you get to the top of those 18 flights of stairs and it isn't a pronouncement and you need your monitor? I'm all for working smarter rather than harder but I've been caught with my pants down and I don't like it.


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## chaz90 (May 11, 2013)

jjdjld said:


> Hi again,
> 
> To answer a few questions that were asked....
> 
> ...



If there are patients that you have doubts on, then those are the ones you should be bringing in a full monitor to potentially work the code. If it is a patient that someone on scene is saying is so obviously dead that I don't need the monitor (IE decomposition, decapitation, lividity, rigor etc.), then why even bother with some jury rigged monitor like thing? Also, I don't think any of these adhoc EKG machines are FDA approved and there's no way I'd be documenting the use of a non approved medical device as part of my pronouncement.


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## jjdjld (May 11, 2013)

Thank you for all your responses. You make a very good point. I will continue to work the way I have been. Hopefully sooner or later they'll cut a bit of weight off of them :wacko:

Thanks again, your help is greatly appreciated.


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## RocketMedic (May 11, 2013)

Are you European or in a supervisory position?


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## feldy (May 30, 2013)

wouldnt that be nice...we also have to confirm DOAs by printing out all Leads I, II, and III and attaching it to the report. We also can run multiple DOAs per shift. Especially if you are on the sprint car. We have to do it for all DOAs whether its medical, or trauma related including all homicides.


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## TheLocalMedic (May 31, 2013)

Minimum of 2 DOAs in a shift?  6 DOAs on the last shift?  

:nosoupfortroll:


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## medicdan (May 31, 2013)

This may be off topic, but i'm curious how many people's systems require you to bring an asystolic strip in order to declare death... In some systems around me, providers are actually forbidden from attaching the monitor to patients they intend to declare dead, "because asystole is a treatable rhythm" and if providers have any doubt based on the physiological indicators of death, they should initiate a full resuscitation. We can make these pronouncements entirely based on physiological findings, and as long as those are documented, some medical directors and MC physicians ask that the monitor not be attached. 

Thoughts?


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## Christopher (May 31, 2013)

emt.dan said:


> This may be off topic, but i'm curious how many people's systems require you to bring an asystolic strip in order to declare death... In some systems around me, providers are actually forbidden from attaching the monitor to patients they intend to declare dead, "because asystole is a treatable rhythm" and if providers have any doubt based on the physiological indicators of death, they should initiate a full resuscitation. We can make these pronouncements entirely based on physiological findings, and as long as those are documented, some medical directors and MC physicians ask that the monitor not be attached.
> 
> Thoughts?



It sounds like they consider anything but decapitation to be a workable arrest.

How bizarre.

They need to <insert phrase not appropriate for work> or shut up and let folks terminate resus responsibly. We print strips with agonal rhythms on them as DOA strips.


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## v3nn3m (Jul 1, 2013)

Someone in my company has a 3/12 lead ecg that hooks up to the ipad he has a Bluetooth adapter and the ecg cables are connected to a small box that takes batteries and transmits the info via Bluetooth to the ipad but he wasn't to use it on the job, but ill find out the brand and model if your interested in it


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