Found this ekg set up

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Aprz

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I didn't listen to the podcast or read it. I was already familiar with Lewis Lead.

I've tried it before, and it didn't help to amplify atrial activity while minimizing ventricular activity. I believe it simply "works" conceptually because the most common mean QRS vector should be around +30 to +60 degrees and this setup would change the leads to be perpendicular to that making them smaller. If the mean QRS vector is different from that, this won't work. For example, if there is right axis deviation (common in pulmonary patients due to enlarged right ventricular enlargement and also probably one of the more common patients to have atrial rhythms) then this would actually position the leads optimally to view ventricular activity instead. To be honest, once you are very familiar with the different SVTs and how they present, they are kind of easy to spot.

If possible, I encourage you to try it on yourself to see. I was not impressed with my own results. I've yet to try it on an actual patient, but I feel pretty comfortable interpreting a lot of rhythms.
 
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StCEMT

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Thanks for the input. I work tomorrow, maybe I will hook myself up to the monitor tomorrow for the sake of science.
 
VFlutter

VFlutter

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I've had a cardiologist ask for it once or twice when we had a patient in sustained SVT vs VT but other than that is pretty obscure.
 
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Aprz

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So did anyone try it? I go to work again on Saturday and can share my results.
 
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StCEMT

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No, we were actually really busy all night surprisingly. Psych calls all day. I work tomorrow and Saturday, gonna try then time permitting.
 
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Aprz

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I forgot to do it today, lol. I totally could've done it too because I had no partner today and ended up leaving early. Tomorrow!
 
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StCEMT

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I did too. I could have as well, I did nothing for the first 4 hours.
 
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Aprz

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Darn it. I forgot. To be fair, I stayed after work for about 2 hours doing PCRs. <_< I remember when people told me that they wanted to become a paramedic because they didn't want to be sitting behind a desk working on a computer on day. I didn't realize that this was literally going to be a mobile cubicle, lol.
 
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StCEMT

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Just did it now. Not really that much different. QRS amplitude was a little smaller, the T wave flattened out (maybe slight inversion), P wave was the same. Lewis lead was cleaner and the only real difference I saw was what looked like a baby p wave (half a block high) right in front of the QRS after the P wave.
 
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Aprz

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StCEMT said:
Just did it now. Not really that much different. QRS amplitude was a little smaller, the T wave flattened out (maybe slight inversion), P wave was the same. Lewis lead was cleaner and the only real difference I saw was what looked like a baby p wave (half a block high) right in front of the QRS after the P wave.
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That's what I figured. The next time I work is on Friday. I told my partner about it today and told her to remind me, lol. I have done fun experiments before like moving the leads around (eg switch the left and right leg leads to show it doesn't change the 12-lead and also moving the green right leg lead anywhere, including the forehead, to show it shouldn't really change it... there are pictures of me doing this, lol).

Like I said, I think the ideal way to really do this is figure out where your mean QRS vector is at, and then you want to rearrange the leads (that you are viewing) to be as perpendicular to this as possible to minimize the ventricular activity; This would make both sides about equally positive and negative minimizing it. I think in most normal axis, Lewis Lead should ideally work. When I tried it on myself (like two years ago?), it didn't really change the ECG in ways that I was hoping it would.
 
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