VirginiaEMT
Forum Lieutenant
- 247
- 0
- 0
How important is it to be able to determine left or right axis deviation in EMS? Why?
How important is axis deviation in EMS?
- Thread starter VirginiaEMT
- Start date
TomB
Forum Captain
- 393
- 82
- 28
TomB probably covered this already within his blog, but Axis is useful for determining a ventricular focus (extreme RAD, for example) versus a supraventricular focus with aberrancy, or the presence of hemiblocks, which could possibly contraindicate antiarrhtymics if two or more blocks are currently present, be it supraventricular, junctional, or intra-ventricular.
Bob Page shows a video of his daughter, five at the time, determining axis deviation using "up, up, down," "down, down, down," etc. It's that easy.
Bob Page shows a video of his daughter, five at the time, determining axis deviation using "up, up, down," "down, down, down," etc. It's that easy.
Christopher
Forum Deputy Chief
- 1,344
- 74
- 48
Axis is useful for ruling in VT but not ruling out VT. It should not be used to support treating SVT w/ aberrancy. I need to finish my VT Myths series.
Here's another approach for determining axis using I and aVF.
DrankTheKoolaid
Forum Deputy Chief
- 1,344
- 21
- 38
Thanks for posting that link Chris. Somehow all this time I have not been aware of you blog. I Love It! Thanks for sharing your excellent knowledge base with us all
Melclin
Forum Deputy Chief
- 1,796
- 4
- 0
the_negro_puppy
Forum Asst. Chief
- 897
- 0
- 0
We are not taught about L/R axis in our 12 lead training. A few people teach themselves. Ill probably have a look over in the future.
the lifepak 12 will tell me anyway right? ^_^
<_<:wub:
the lifepak 12 will tell me anyway right? ^_^
<_<:wub:NYMedic828
Forum Deputy Chief
- 2,094
- 3
- 36
SameWe are not taught about L/R axis in our 12 lead training. A few people teach themselves. Ill probably have a look over in the future.
the lifepak 12 will tell me anyway right? ^_^
Jambi
Forum Deputy Chief
- 1,099
- 1
- 36
We were taught Axis Deviation in my paramedic program but the focus was using as a tool to confirm suspicion of a cardiac event when the 12-lead wasn't spitting out information. We were taught nothing about using it to identify LVH,VT, or anything else.
ZootownMedic
Forum Lieutenant
- 163
- 9
- 18
VT will have an extreme right axis which is useful in ruling it in. I have never heard of it being useful in determining LVH though or any other types of enlargement or hypertrophy.....I didn't think an axis was a diagnostic tool for this, just examining specfic V-leads.
Christopher
Forum Deputy Chief
- 1,344
- 74
- 48
ZootownMedic
Forum Lieutenant
- 163
- 9
- 18
Interesting....that is the first I have ever heard of it. I was taught that a wide-complex V-tach is going to always have a extreme right axis. This and being able to measure the nader point assist in differentiating it from say SVT with abberancy.
Please....explain?
Christopher
Forum Deputy Chief
- 1,344
- 74
- 48
It all depends on where the VT starts and how it goes out through the ventricles.
An origin in the apex is going to have a different axis than an origin in the right ventricular outflow tract. An origin in the right ventricle will have an LBBB-morphology and could have right axis deviation. An origin in the left ventricle will have an RBBB-morphology and could have a superior axis. Lots of options.
A picture is worth 1000 words, so while this paper gets pretty deep, the illustrations of the ventricles with accompanying ECG's is great and helped me a lot.
Last edited by a moderator:
TomB
Forum Captain
- 393
- 82
- 28
This is one of the most dangerous EMS myths ever created (that VT will have a right superior axis). As Christopher said, a right superior axis can help rule in VT but VT can have an axis in any quadrant. The most important criterion for VT is "wide and fast". This is one area where 12-lead ECG education has done some harm, IMHO.
NYMedic828
Forum Deputy Chief
- 2,094
- 3
- 36
So, I just read Tom's 6 parts to axis deviation.
Absolutely phenomenal read, so glad I read it. I was clueless before.
Now my question is, what happens when you can't find a lead that is relatively equiphasic, or can't decide which is the most relatively equiphasic?
Like this for example
How does one decide where to start on choosing a vector?
Absolutely phenomenal read, so glad I read it. I was clueless before.
Now my question is, what happens when you can't find a lead that is relatively equiphasic, or can't decide which is the most relatively equiphasic?
Like this for example
How does one decide where to start on choosing a vector?
Christopher
Forum Deputy Chief
- 1,344
- 74
- 48
Leads I and aVF are both positive, so you can localize it to between 0 and 90 degrees at least (i.e. Normal). Furthermore, looking at aVL you can see it points away. The perpendicular lead to aVL is Lead II, so it should be to the "left" of Lead II but to the "right" of aVF because Lead I is positive.
Somewhere between 60 and 90, probably closer to 90 since aVL is more negative than positive.
I've done up a drawing to help, where I fill in the halves associated with each lead's polarity on the axis wheel. Where they all intersect is where your axis lies.
Last edited by a moderator:
Christopher
Forum Deputy Chief
- 1,344
- 74
- 48
Much cleaner picture. Lead labels are on their positive pole, dashed lines are the leads negative pole. Please excuse my inability to draw 30 degree increments.
Christopher
Forum Deputy Chief
- 1,344
- 74
- 48
Sublime
LP, RN
- 264
- 6
- 18
There is some great resources here for learning how to determine Axis in this thread, but no where that explains how axis can help in clinical findings.
It is mentioned that identification of Axis can help you rule in VT, find blocks, find LVH.... but I can't find anything that really explains how to use axis to find these things.
It is mentioned that identification of Axis can help you rule in VT, find blocks, find LVH.... but I can't find anything that really explains how to use axis to find these things.