How important is axis deviation in EMS?

[Christopher]

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.

Clinical uses of axis deviation...hmm.

Dr. Tomas Garcia would say, "consider the company it keeps."

• Right superior axis? Ventricular rhythms or lead misplacement
• Pathological left axis deviation? Left Anterior Fasicular Block from a new or old MI/ischemia
• Right axis deviation? Acute/chronic pulmonary diseases
• LBBB and RAD? Very rare and always abnormal, consider a technical failure as the cause.

If you factor in the Z-axis as well as the frontal axis you can glean a lot more information:

• I and V6 opposite? Consider lead misplacement
• Left axis deviation and poor R-wave progression? Consider MI (old or new).
• Right axis deviation and tall R-waves in right precordials? Consider Right-heart strain (acute or chronic)

The honest answer is you probably don't need it. A proficient paramedic can treat all manners of patients effectively without ever knowing the mean axis of the heart. However, as with anything, the greater your understanding of how the body functions, the better clinical care you will provide your patient.

 

[MSDeltaFlt]

Now learning all of the what's and the why's of axis deviation doesn't hold a lot of water unless you know how to apply the knowledge in the real world.

Now what is one good example of a real world application of axis deviation? I mean besides ventricular based rhythms. I'm talking about some of the stuff we see on a regular basis.