EKG stumped me a bit

[eatsleepsurf88]

Hey all,

First post here on EMT Life but I regularly read the forums.

Alright so background on the call. Dispatched to the medical aide on outside of a church late in the night, 18 y/o female PT complaining of "flutering heart" and mild SOB. Get her in the truck throw her on a little o2 and then on the monitor. 3 lead set up, o2 sat 100 pressure 114/58. On the monitor screen I can already see "rabbit ears" in lead III. So I set her up on the 12 lead, get the printout and take a look. NOTHING at all remarkable except in lead III. New medic here, any input?

 

[eatsleepsurf88]

HR in the 60's BTW

 

[fast65]

Is it possible for you to post a strip by any chance?

 

[STXmedic]

Without an ECG, there's really not a whole lot to help you with.

 

[Shishkabob]

Normal sinus rhythm.

 

[eatsleepsurf88]

Is it possible for you to post a strip by any chance?

Ya I will try and get that on here waiting for someone at base to email it to me.


And in response to the normal sinus rhythm, yes it was normal sinus rhythm but I have yet to see a lead III look like that without showing anything else on the 12. Maybe I missed something on the EKG due to being at the a** end of a 48 but I don't think that I did.

Thanks for the responses everyone

 

[systemet]

It could be a filtering issue. Most monitors display and print in "monitoring mode", with a fairly tight filter ~ 0.5-30Hz, then print the 12-lead with less filtering in a "diagnostic mode" or ~ 0.05-150 Hz (actual number varies with model). This is the reason why sometimes you see spurious elevation on the monitor screen or on a quick 3-lead printout, that disappears when you do a 12.

That being said, I haven't heard of this making a difference with the gross QRS morphology (obviously you could argue that if the ST elevation is altered then the terminal QRS could be). It also seems that more filtering (i.e. monitoring mode) would make it less likely to see QRS notching, as this typically a higher frequency signal. I'd almost expect it to be the other way around -- not see the notching on the 3-lead / monitor-mode, and then loosen up the low-pass filter, and see notching appear.

What did V1 look like?

 

[TroyOck]

maybe her heart was fluttering because she saw you?


that was adorable

 

[eatsleepsurf88]

It could be a filtering issue. Most monitors display and print in "monitoring mode", with a fairly tight filter ~ 0.5-30Hz, then print the 12-lead with less filtering in a "diagnostic mode" or ~ 0.05-150 Hz (actual number varies with model). This is the reason why sometimes you see spurious elevation on the monitor screen or on a quick 3-lead printout, that disappears when you do a 12.

That being said, I haven't heard of this making a difference with the gross QRS morphology (obviously you could argue that if the ST elevation is altered then the terminal QRS could be). It also seems that more filtering (i.e. monitoring mode) would make it less likely to see QRS notching, as this typically a higher frequency signal. I'd almost expect it to be the other way around -- not see the notching on the 3-lead / monitor-mode, and then loosen up the low-pass filter, and see notching appear.

What did V1 look like?

Awesome explanation thank you for that. I have been trying to get the 12 lead but apparently some one has deleted the scanned copy off the base computer. Anyways V1 was completely unremarkable, textbook.

maybe her heart was fluttering because she saw you?


that was adorable

Lol ya I was thinking that must be it

 

[mikie]

Was it a LifePak, by chance?

if you guys haven't used the monitor much since, it's likely the EKG is still in the LP's archive mode..

 

[MSDeltaFlt]

Going off of report or conjecture without an actual 12 lead ECG to confirm leaves me only with this. Rabbit ears on a single limb lead is at the worst a conduction delay and is usually benign in nature. Heart rate and blood pressure were within normal limits on a young female so I would definitely NOT treat the monitor under any circumstances.

At the most I'd give O2, INT, and enhance calm throughout transport to a clinic room.

Just mu 0.02

 

[fma08]

- 1 for looking for "Rabbit Ears"
+1 for looking for more info though ^_^

 

[eatsleepsurf88]

if you guys haven't used the monitor much since, it's likely the EKG is still in the LP's archive mode..

It is a Life Pack 12, but we are in a pretty busy system so it is used everyday

Going off of report or conjecture without an actual 12 lead ECG to confirm leaves me only with this. Rabbit ears on a single limb lead is at the worst a conduction delay and is usually benign in nature. Heart rate and blood pressure were within normal limits on a young female so I would definitely NOT treat the monitor under any circumstances.

At the most I'd give O2, INT, and enhance calm throughout transport to a clinic room.

Just mu 0.02

I completely agree with you and I treated as such. They drilled "treat the patient not the monitor" in school I was just looking to see if I missed anything or if someone has had the same experience.

- 1 for looking for "Rabbit Ears"
+1 for looking for more info though ^_^

Lol I knew I was going to catch something for that...

Thanks for the replies everyone!