How do you document v4r?

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medicdan

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I am a newer medic, and continue to read EKG blogs and books, in hopes of keeping my skills up. I've cared for several obvious STEMIs recently and a few less obvious, and seem to be juggling a lot of monitor paper for my documentation, which begs a question:

Can we "tell" our monitor we are acquiring a right sided EKG? I find myself manually writing the "R" on the 12-lead printout, but then need to search for which time-stamp was the right sided for my documentation, and worry that it will get lost in the shuffle of my ePCR. I always leave an original EKG (with "R"), but know the right sided won't be identified when my PCR is faxed.

Is there any way (either with the Zoll E-Series or LP series) to "mark" an EKG as right sided, ideally so it prints with that clear, and shows up differently in the computer? Can I do this for just an V4R, or an entire right sided EKG? What about posterior?

If no technological solution, how do you do it low-tech?
 
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For low-tech documentation, we mount our strips on paper and write "v4r"

When I attach a strip to my chart through image trend, I document that it's a right-sided 12 lead or just v4R in the comment section.

I also print out a copy of the strip, to hand to the doc at the ED. I make a note of when I did the 12 lead on the facesheet or something so I make sure it correlates with my chart
 
When I do a right sided 12-lead I remove V1-2 so they're two dotted lines, that tells me it's right sided. If I'm doing a posterior I'll move v3 to v4r then use v4-6 as 7-9 with v1-2 removed. Then I write on the print out v4r and 7-9 if applicable.

When I do my flow chart in the 12-lead notes I'll note it, either "v4r" or "v3->v4r and posterior precordial leads". Then in my ECG Interpretation flow chart notes I'll note it again then write out my interpretation.

I don't document procedures in the narrative, my narratives are very short and all subjective since my OAP is done via flows and drop downs and is imported by HealthEMS into the written narrative after my subjective narrative.

Does that make any sense at all? My QA/CQI likes the way I document and has used it as an example. Most ERPs here know if they're getting a right sided/posterior from me it'll have v1-2 blank and then be labeled appropriately.
 
Robb said:
When I do a right sided 12-lead I remove V1-2 so they're two dotted lines, that tells me it's right sided. If I'm doing a posterior I'll move v3 to v4r then use v4-6 as 7-9 with v1-2 removed. Then I write on the print out v4r and 7-9 if applicable.
Click to expand...

that's slick, I like it.
 
Write and "R" next to V4 and explain in either a comments section on the PCR or in narrative.
 
DEmedic said:
For low-tech documentation, we mount our strips on paper and write "v4r"

When I attach a strip to my chart through image trend, I document that it's a right-sided 12 lead or just v4R in the comment section.

I also print out a copy of the strip, to hand to the doc at the ED. I make a note of when I did the 12 lead on the facesheet or something so I make sure it correlates with my chart
Click to expand...

This. In my narrative, I'll put EKG #(whatever), V4R, and then the interp
 
Robb said:
When I do a right sided 12-lead I remove V1-2 so they're two dotted lines, that tells me it's right sided. If I'm doing a posterior I'll move v3 to v4r then use v4-6 as 7-9 with v1-2 removed. Then I write on the print out v4r and 7-9 if applicable.

When I do my flow chart in the 12-lead notes I'll note it, either "v4r" or "v3->v4r and posterior precordial leads". Then in my ECG Interpretation flow chart notes I'll note it again then write out my interpretation.

I don't document procedures in the narrative, my narratives are very short and all subjective since my OAP is done via flows and drop downs and is imported by HealthEMS into the written narrative after my subjective narrative.

Does that make any sense at all? My QA/CQI likes the way I document and has used it as an example. Most ERPs here know if they're getting a right sided/posterior from me it'll have v1-2 blank and then be labeled appropriately.
Click to expand...

I'm stealing.
 
medicdan said:
I am a newer medic, and continue to read EKG blogs and books, in hopes of keeping my skills up. I've cared for several obvious STEMIs recently and a few less obvious, and seem to be juggling a lot of monitor paper for my documentation, which begs a question:

Can we "tell" our monitor we are acquiring a right sided EKG? I find myself manually writing the "R" on the 12-lead printout, but then need to search for which time-stamp was the right sided for my documentation, and worry that it will get lost in the shuffle of my ePCR. I always leave an original EKG (with "R"), but know the right sided won't be identified when my PCR is faxed.

Is there any way (either with the Zoll E-Series or LP series) to "mark" an EKG as right sided, ideally so it prints with that clear, and shows up differently in the computer? Can I do this for just an V4R, or an entire right sided EKG? What about posterior?

If no technological solution, how do you do it low-tech?
Click to expand...

The low-tech solution is R-wave progression. The introduction of right sided precordial leads obliterates the normal R-wave progression, making it immediately obvious that the leads are not in a standard position.

If the person on the receiving end doesn't notice something is fishy...
 
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