Reading 12 leads

[Epi-do]

Is it really that hard to detect ST elevation on a 12 lead? I had a run the other day where I took a patient to one of our heart hospitals and was told that I was one of the few medics in a long time that had correctly read the 12 lead I had done on my patient.

I just thought it was a rather sad comment to hear from the staff. Surely most people don't have that much trouble with it, do they?

 

[reaper]

Not really. Now different Dr's and hospitals very on STEMI's. I have seen them range any where from 0.5-2.0mm of elevation for a STEMI to be called.

There are a lot of medics that have no clue on how to break a 12 lead down. They count on the monitor interpretation for every thing. That is the sad state of under education!

 

[MSDeltaFlt]

Yes, there are medics, nurses and even doctors who will completely trust and go by the computer interpretation en lieu of sitting down and taking the time to interpret it themselves. It inhaleth extremely I know, but it is what it is.

 

[DT4EMS]

We turned all of our interpretations off. We were not allowed to use them.

 

[karaya]

That is the sad state of under education!

Under education or too much dependence on over automation??

 

[ruffems]

I tend to agree with the crutch that many use, the dreaded interpretation.

I interpret my own, I never use the interpretation from the machine.

I also am the only one in my EMS system who does right sided EKG's though.

 

[Epi-do]

We turned all of our interpretations off. We were not allowed to use them.

I wish they would turn it off on our machines. I have to fold the strip down so I don't see the interpretation when looking at it. That way, I am not influenced by what it thinks is there.

 

[daedalus]

Ah the good ole interpretation. I am going to learn to read 12 leads according to my class syllabus and the text I bought for it required for school. I am actually excited to have the ability to read them, what an amazing skill.

For now at work, I just like to read what the machine says and than look at the tracings to see if I can see what the machine does, its a good learning tool for me as long as I recognize the machine may not always be right.

 

[TomB]

I addressed this issue recently at the PH12ECG blog.

See:

The problem of ST segment elevation

ECG mimics of acute STEMI

Tom

 

[emtfarva]

I have a medic that will read the 12 lead and then look at what the computer thinks.

 

[rhan101277]

We don't have 12 leads on our trucks. We just have three lead, which basically gives rate and rhythm. Guess it takes alot of time to put on all the leads. You could probably see a bad STEMI on a three lead.

 

[medic417]

We don't have 12 leads on our trucks. We just have three lead, which basically gives rate and rhythm. Guess it takes alot of time to put on all the leads. You could probably see a bad STEMI on a three lead.

30 seconds and then wait less than 1 minute for your 12 lead to capture and print.

You can see indications that there could be a MI but are very limited by the views it presents. Now you can use a 3 lead and do a modified 12 lead if you know what your doing.

 

[VentMedic]

We don't have 12 leads on our trucks. We just have three lead, which basically gives rate and rhythm. Guess it takes alot of time to put on all the leads. You could probably see a bad STEMI on a three lead.

No. The 3 lead is only looking at one view of the heart. It would take more time to arrange the 3 leads for the different with the accuracy being in question as well. You can do modified V leads with a 3 lead but it would not give the same accuracy as a 5 lead or 12 lead.

When you study 12 lead EKG, hopefully they will get into the difference between viewing from a frontal and horizontal plane as well as the vectors. The V leads are from a horizontal plane. Understanding unipolar, bipolar, Einthoven's Law and Wilson's central terminal with give you the point of view the electrodes and leads are looking at.

 

[marineman]

30 seconds and then wait less than 1 minute for your 12 lead to capture and print.

You can see indications that there could be a MI but are very limited by the views it presents. Now you can use a 3 lead and do a modified 12 lead if you know what your doing.

I understand doing a modified 3 lead to get some different views but just wondering is the diagnostic quality vs monitoring quality still going to affect it or is there a way to switch a 3 lead to diagnostic? I've never seen diagnostic on a 4 lead here but I guess it might be an option.

Edit: We learned to read 12's in class but not well enough that I feel completely comfortable with it. Luckily one of the classes I have left next semester is a full semester long ECG interpretation class so I should come out of that sitting pretty decent.

 

[VentMedic]

I understand doing a modified 3 lead to get some different views but just wondering is the diagnostic quality vs monitoring quality still going to affect it or is there a way to switch a 3 lead to diagnostic? I've never seen diagnostic on a 4 lead here but I guess it might be an option.

Leads I, II and III are bipolar and view on the frontal plane.

The V leads are unipolar and view on the horizontal plane.

If bipolar leads are used for MCLs or modified chest (V) leads, they may aid in determining morphology of aberrancy vs ventricular but may not view ischemia.

 

[TomB]

We turned all of our interpretations off. We were not allowed to use them.

May I please know where you work? The only EMS system I had previously been aware of that turned off the computerized interpretive algorithm is Ottawa, Canada.

Thanks!

Tom

 

[Juxel]

We have interpretations turned off as well. Our service provides extensive training on 12-lead interpretation, and we just did a very large study on how nitro changes 12-leads.

The flagship hospital that our service is associated with had the cardiologists involved in our 12-lead education and they became so comfortable with the street medic's ability to read a 12-lead that we have been taking people straight to the cath-lab even if they have a 'normal' EKG upon hospital arrival (STEMI in field, gone with MONA).

There have been a couple instances of pericarditis EKGs being misinterpreted for STEMI's, but that is due to the crew lacking a good history and possibly erring on the side of being overly cautious.

 

[TomB]

We have interpretations turned off as well. Our service provides extensive training on 12-lead interpretation, and we just did a very large study on how nitro changes 12-leads.

The flagship hospital that our service is associated with had the cardiologists involved in our 12-lead education and they became so comfortable with the street medic's ability to read a 12-lead that we have been taking people straight to the cath-lab even if they have a 'normal' EKG upon hospital arrival (STEMI in field, gone with MONA).

There have been a couple instances of pericarditis EKGs being misinterpreted for STEMI's, but that is due to the crew lacking a good history and possibly erring on the side of being overly cautious.

Is that Hennepin County?

Tom

 

[Juxel]

Is that Hennepin County?

Tom

Yes. Have you seen the study?

 

[TomB]

I have seen the study! I also know a few people from Hennepin County. Awesome system.

Tom