Are there rural systems that place 12-lead capable monitors on BLS trucks for early ECG measurement/serial assessments, and automatically send the tracing to the ED for interpretation? I can imagine that could be a valuable tool if no ALS is available... for the ED to determine whether to activate a cath team. BLS would, of course, be trained on electrode placement, and the monitor would be used only for the 12-leads, and of course AED mode.
How accurate are the LifePak/Zoll Defibs at Identifying Rhythms?
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Brandon O
Puzzled by facies
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Los Angeles has played with this, and Physio is making a standalone "monitor" for such services now (hook it up, get a diagnostic-quality 12-lead, transmit it -- no interventions, can't print, just electrodes and a modem).
http://www.physio-control.com/ProductDetail.aspx?id=2147484151
Interesting. Thanks for sharing.
DrParasite
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was the patient actually having an MI, or was it a false positive?
rmabrey
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They weren't having an MI. He read the words at the top "acute MI" or whatever it says. They were in NSR.
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VFlutter
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I work with Telemetry monitors so it is kind of off topic but I always laugh when every patient in perfect A Flutter is labeled as Sinus Rhythm. They can never seem to get that right.
Physio Control
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My name is Erik and I'm the communications program manager at Physio-Control. I came across this discussion and thought it would be a good opportunity to check in with Physio's research and clinical departments for their perspective, with the hope that it would be helpful to forum members. Here's what they had to say...
"TomB is correct about the importance of good ECG quality, with correct location of electrodes and with minimization of baseline wander and muscle artifact. The algorithms in the Physio-Control devices all do signal averaging of the dominant P-QRS-T complexes to reduce artifact, but if there is too much artifact, the averaging cannot remove it all using only ten seconds of ECG. If excessive artifact causes measurement errors, those can lead to interpretation errors. If ECG artifact makes it challenging for you to measure the ECG, it is best to capture another, cleaner ECG. To reduce muscle artifact, make sure that the patient’s limbs are supported and that their muscles are relaxed during the 12-lead. If respiration is causing baseline wander, have the patient exhale half of their air and then stop breathing during the ten seconds it takes for a repeat ECG.
The algorithms in the Physio-Control devices all attempt to identify the STEMI imposters, and when identified they give statements like pericarditis, early repolarization, LVH, LBBB, or ventricular pacing rather than ACUTE MI or STEMI. With LBBB, the Glasgow algorithm will still give the STEMI statement if the Sgarbossa criteria are met for LBBB with STEMI. The algorithms have fairly sophisticated rules for STEMI, taking into account measurements such as QRS duration and R, S, and T amplitudes. The Glasgow program takes age and gender into account for STEMI. In general, the ST elevation thresholds are lowest for women and highest for young men (for example, see the current AHA recommendations for STEMI criteria).
One advantage that experienced physicians and experienced paramedics have over the automated algorithms is in taking into account the patient’s description of symptoms. A cardiologist may call it STEMI for a patient with typical symptoms but slightly short on ST elevation when they say, “It feels like an elephant is stepping on my chest.” A cardiologist may not activate the cath lab for a patient who has marginal ST elevation but vague symptoms with an alternate explanation for those symptoms. The automated algorithms do not have a way of accepting such information about symptoms.
Operating instructions for these devices recommend that 12-lead ECG interpretations be over-read by a qualified person before making treatment decisions."
The algorithms in the Physio-Control devices all attempt to identify the STEMI imposters, and when identified they give statements like pericarditis, early repolarization, LVH, LBBB, or ventricular pacing rather than ACUTE MI or STEMI. With LBBB, the Glasgow algorithm will still give the STEMI statement if the Sgarbossa criteria are met for LBBB with STEMI. The algorithms have fairly sophisticated rules for STEMI, taking into account measurements such as QRS duration and R, S, and T amplitudes. The Glasgow program takes age and gender into account for STEMI. In general, the ST elevation thresholds are lowest for women and highest for young men (for example, see the current AHA recommendations for STEMI criteria).
One advantage that experienced physicians and experienced paramedics have over the automated algorithms is in taking into account the patient’s description of symptoms. A cardiologist may call it STEMI for a patient with typical symptoms but slightly short on ST elevation when they say, “It feels like an elephant is stepping on my chest.” A cardiologist may not activate the cath lab for a patient who has marginal ST elevation but vague symptoms with an alternate explanation for those symptoms. The automated algorithms do not have a way of accepting such information about symptoms.
Operating instructions for these devices recommend that 12-lead ECG interpretations be over-read by a qualified person before making treatment decisions."
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OrlandoRMAMedic
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I wish more people, from the companies that we get equipment from, would pop their heads in here more often. This is awesome and thank you for the explanation.
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