Does anyone know where I can find a list of all the possible ECG interpretations on the Phillips Heartstart Mrx? Here in VA, basics are allowed to acquire 12 leads under local protocol and I would like to have a very basic idea of what some of the analysis printouts mean and what the threshold triggers are for them.
Phillips Mrx ECG Analysis
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Brandon O
Puzzled by facies
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Many of these are going to be rather complex. The algorithm behind most resulting flags will consider numerous factors.
Jason
Medic
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--Not sure I understand exactly what you are asking. Do you want to better understand the computer generated interpretation of the 12-Lead? Not per-say the actual self interpretation of reading 12-Leads?
The algorithm by which cardiac monitors "interpret" rhythms and 12-Leads has multiple steps and the number of different possible printouts for interpretations is A LOT.
I would say - to any EMT - understand that ***Acute MI*** or ***STEMI*** is bad, and treat accordingly. Also, and really most important to me -- treat your patient. Using your EMT skills of assessment, formulate a plan of action and execute. Learning more is great and sounds like you should get your ALS; not just to learn more, but to do more.
Exactly. Not that understanding the interpretation would impact my decision as a basic to request ALS (at the BLS level, it shouldn't). I just feel a little dumb when something other than Sinus-Tach, STEMI, ACUTE MI is shown.
SandpitMedic
Crowd pleaser
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Is this real right now? That's not how any of this works.
If you have to rely on the monitors (almost always wrong) interpretation of a 12 lead then you have no business whatsoever performing 12 leads.
If you have to rely on the monitors (almost always wrong) interpretation of a 12 lead then you have no business whatsoever performing 12 leads.
PotatoMedic
Has no idea what I'm doing.
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This is not what you ask for. But this is what you want.
http://www.amazon.com/Basic-Arrhythmias-Edition-Gail-Walraven/dp/0135002389
http://www.amazon.com/Basic-Arrhythmias-Edition-Gail-Walraven/dp/0135002389
I am guessing they primarily don't do 12-leads to interpret it themselves. They probably do 12-leads to either transmit it or hand it off to the ER. If they transmit it, the ER could activate the cath lab or divert the ambulance to a facility with a cath lab. If they hand it off to the ER only without transmitting, the ER can see what the 12-lead looked like before the patient received NTG and/or see any changes when they do another 12-lead.
To the OP, you are gonna learn a lot of what that stuff means. People who interpret the 12-lead and the computer interpreting it will use similar terminology. The computer algorithm is going to be similar to how people interpret it, but written in a way that the computer is going to understand it.
I think the computer is actually pretty good at interpretation, but it does miss things sometimes. I feel like a lot of people interpretation skills don't go beyond the orange coloring book written by a cocaine addicted plastic surgeon pedophile. Both machine and people will sometime laughably make bad interpretations. I see it all the time in the EKG Club.
This.
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There are lots of places that don't have paramedics that do allow BLS crews to transmit 12 leads to the receiving hospital. When the monitor says STEMI, that would be a good one to transmit so the doc can then provide orders.
SandpitMedic
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Sigh.... Defenders of the good idea fairy.
If you don't know what you're looking for you probably don't know how to troubleshoot. How many times have you seen people hold a 12 lead upside down, place the wrong leads or leads out of sequence. How could a doc know it's a reliable 12 lead when the person transmitting can't even tell what they're looking at!? It's a stupid idea without the proper training and knowledge in cardiology - what is the heart doing, what picture are you getting, what could be going on? Not to mention, what about treatment? Can't even treat most arrhythmias except with the use of aspirin and maybe MAYBE nitro in some places as a Basic. But what are the other complications of treatments or cardiac disease processes!? How about treat the patient, not the monitor? Look at the presentation, history, and get the picture... What about mimics? What about the amount of medics who are responsible for false activations already - adding Bs into the mix will only further the increase in statistics of false activations because they don't know what they are looking at. Giving more ammo to those who like to see us statistically performing poorly (i.e. Unions, politicians, lobbyists,etc).
My point is if you don't know what to look for- how to look for it - or what you're even looking at.... Then the rest of that stuff is a stretch. As far as monitor interpretations go: if you're using that technology you're worthless and you should go take a class. Relying heavily on the electronic interpretation is bad any way you slice it for your patient.
If you're a defender of Basics performing 12 leads then you should also be a proponent for higher education for EMS providers and increased educational barriers to entry in our field. That needs to come first, before we start figuring out ways to dumb down ALS skills even further than we already have in my opinion.
If you don't know what you're looking for you probably don't know how to troubleshoot. How many times have you seen people hold a 12 lead upside down, place the wrong leads or leads out of sequence. How could a doc know it's a reliable 12 lead when the person transmitting can't even tell what they're looking at!? It's a stupid idea without the proper training and knowledge in cardiology - what is the heart doing, what picture are you getting, what could be going on? Not to mention, what about treatment? Can't even treat most arrhythmias except with the use of aspirin and maybe MAYBE nitro in some places as a Basic. But what are the other complications of treatments or cardiac disease processes!? How about treat the patient, not the monitor? Look at the presentation, history, and get the picture... What about mimics? What about the amount of medics who are responsible for false activations already - adding Bs into the mix will only further the increase in statistics of false activations because they don't know what they are looking at. Giving more ammo to those who like to see us statistically performing poorly (i.e. Unions, politicians, lobbyists,etc).
My point is if you don't know what to look for- how to look for it - or what you're even looking at.... Then the rest of that stuff is a stretch. As far as monitor interpretations go: if you're using that technology you're worthless and you should go take a class. Relying heavily on the electronic interpretation is bad any way you slice it for your patient.
If you're a defender of Basics performing 12 leads then you should also be a proponent for higher education for EMS providers and increased educational barriers to entry in our field. That needs to come first, before we start figuring out ways to dumb down ALS skills even further than we already have in my opinion.
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Whoa.
It is not difficult to place a 12 lead properly. Placement. That's all. It's done by EMTs all over the place. Leave a diagram on the monitor if you must.
There is a good part of America that will never have timely access to ALS. I truly believe that every square mile of this country should have access to a paramedic, but there is no way that it can be timely for rural America. MIs are a legitimately time sensitive emergency and there is a place for BLS ambulances in their care, when they are the only resource. That might mean that a helicopter gets launched or a different destination selected. Maybe it means a paramedic intercept when might otherwise not occur.
There are reasons for BLS to have the ability to acquire 12 leads and transmit them for interpretation. It's not needed in many areas, but in rural America it might actually make a difference. Check out Mission: Lifeline, which is an AHA initiative in Montana. Similar programs exist in Wyoming and the Dakotas, as well as New Zealand.
Again, all we are talking about here is EMTs and AEMTs acquiring a 12 lead and transmitting it for interpretation so a transport decision can be made. Non-paramedics will not be interpreting. They won't be treating (beyond basic BLS level interventions). They won't be calling cardiac alerts.
Deep breaths.
SandpitMedic
Crowd pleaser
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I like the diagram idea, but again it reinforces the don't learn the recipe, just look at the cook book mentality. I believe that leaves out key ingredients to establishing a critically thinking provider and promotes the "cook book" medic trend.
Time sensitive MIs, yes, then teach twelve leads and basic cardiology and cardiac disease process to a level of understanding not just to pass a test. Not just shoot a picture and send it off. You have good points, and yes - wooooosahhhh. I'll chill. I just want education standards to be higher, for in the long haul it just creates shortcuts in learning. (Not that it can't be relearned or retaught, but old habits die hard. Starting out with cheat sheets should not become a new norm or standard operating procedure).
Perhaps rural America should do away with Basics, and only certify AEMTs. If people want to "help people" then they should take the time to reach the level where they can do more than just take a BP. I'm sure there are objections to that idea, but the truth is it could be done and could solve a lot of other issues as well. I'm not trying to knock Basic skills; at first glance it may appear so but I am not.
Again, I got a little ahead of myself, but I still feel there are alternatives to dumbing it down to transport decision algorithms. ALS should be dispatched to cardiac calls from the jump.
SandpitMedic
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EKG interpretation is part of the AEMT curriculum.
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I don't believe that is correct. The National EMS Scope of Practice Model has nothing regarding AEMTs having any sort of cardiac knowledge base. Some states may choose to use the older Intermediate-99 curriculum as the educational model (or a hybrid of) for their AEMTs but that is fairly rare.
At a certain point it comes down to a resources issue. I too think that paramedics should be dispatched to any suspected cardiac call, but even where I work it can take us an hour to reach the scene. If the BLS first response people grab a 12 lead, transmit it, and then get a helicopter going before I ever get on scene, that is awesome. Even if the helicopter swoops in and we never make patient contact, that is more than fine. As for interpretation by lower levels, how often will they get to practice? To what extent can we expect a volunteer who responds to 50 medical calls a year to be proficient at interpretation? Doesn't it make sense to take much of the guesswork out of it by getting a physician to interpret it?
At the end of the day, I want EMTs that don't run very many calls to follow a cookbook because the reality is that they will never gain the experience nor the education to be able to adequately critically think through calls. Most here should know that I wholeheartedly wish for increased EMS education standards and believe that everyone should have access in some form to a well educated paramedic staffed ambulance. But to fill the inevitable gaps in rural areas and make a difference in actually time sensitive cases, we need to have first responders, and it's not realistic to expect that their education be on par with those that do this for a living.