What is this rythm

[rhan101277]

 

[traumateam1]

The uh-oh rhythm?
I'll tell you in a little bit when I take my ACLS course lol!

 

[Ridryder911]

A-fib and those are not "P" waves their "F" waves (actually artifact in this case).

R/r 911

 

[reaper]

Yep, look at the irregularly irregular rhythm. There is a lot of artifact present, but look at the rhythm itself.

 

[traumateam1]

Oh! I was gonna ask if that was a lot of artifact in the ECG or not. ^_^

 

[rhan101277]

Yes I think we use a 1980's ish ECG system. What about using the R-R interval to double-check a-fib? What is the best way to do it? Count the squares between each R-R interval?

 

[Ridryder911]

Yes I think we use a 1980's ish ECG system. What about using the R-R interval to verify a-fib?

Doesn't matter if you use the 50's ECG system. The R-R is regularly irregular. See that there is a set pattern. As well, no real defined "P' waves, yes artifact but nothing to distinctly say that it is a P wave.

R/r 911

 

[Hastings]

That's a textbook strip right there.

 

[dmiracco]

I agree with ryder911, controlled A-FIbb.h34r:

 

[rhan101277]

Doesn't matter if you use the 50's ECG system. The R-R is regularly irregular. See that there is a set pattern. As well, no real defined "P' waves, yes artifact but nothing to distinctly say that it is a P wave.

R/r 911

It would just be nice if we had machines with higher resolutions like what they have in the ER. Those ones check the rythm themselves, but the doctor looks at it to.

 

[VentMedic]

It would just be nice if we had machines with higher resolutions like what they have in the ER. Those ones check the rythm themselves, but the doctor looks at it to.

NEVER EVER trust a machine interpretation. We don't even have our machines, either field or hospital, programmed for the interpretation.

 

[MSDeltaFlt]

NEVER EVER trust a machine interpretation. We don't even have our machines, either field or hospital, programmed for the interpretation.

Yeah, whenever I see someone, even those with MD or DO behind their name, look soley at the interpretation never even glancing at the ECG itself, I just chringe.

 

[mikie]

NEVER EVER trust a machine interpretation. We don't even have our machines, either field or hospital, programmed for the interpretation.

So how do we know to trust an AED if it warrants a shock? The machine interpreted it...

 

[daedalus]

Yeah, whenever I see someone, even those with MD or DO behind their name, look soley at the interpretation never even glancing at the ECG itself, I just chringe.

Why cringe? Machines do not make mistakes like we do. Some very very very intelligent folks wrote the code for rhythm interpretation software used in modern machines. These people are way smarter than your average paramedic or even doctor.

 

[rhan101277]

Why cringe? Machines do not make mistakes like we do. Some very very very intelligent folks wrote the code for rhythm interpretation software used in modern machines. These people are way smarter than your average paramedic or even doctor.

I think it must be a board of doctors that determine what type of rythms the machine can interpret. But it is always good to look at the strip and make sure. Since software can hose up from time to time, look at computers. I almost went into medical equipment calibration field, out of electronics engineering from college. It was a interesting field.

 

[rhan101277]

So how do we know to trust an AED if it warrants a shock? The machine interpreted it...

P.S. I like your icon under your name.

 

[VentMedic]

I think it must be a board of doctors that determine what type of rythms the machine can interpret. But it is always good to look at the strip and make sure. Since software can hose up from time to time, look at computers. I almost went into medical equipment calibration field, out of electronics engineering from college. It was a interesting field.

I can hit the analyze button 3 different times on the same patient within the same minute and get 3 different interpretations. The patient can inspire or exhale and that will totally change the interpretation.


This article gives a good overview as to the ACC/AHA statement that the interpretation must be verified by a qualified human. Where you see a reference number, you can do more research on the topic.

ACC/AHA CLINICAL COMPETENCE STATEMENT ON ELECTROCARDIOGRAPHY AND AMBULATORY ELECTROCARDIOGRAPHY
J Am Coll Cardiol 2001;VOLage-page

ACC/AHA Clinical Competence Statement on Electrocardiography and Ambulatory Electrocardiography


[FONT=Arial,sans-serif]III. Twelve-Lead Electrocardiogram[/FONT]

http://www.acc.org/qualityandscience/clinical/competence/ECG/III_electrocardiogram.htm


For AEDs:

YOU as the clinician will have some clinical information at your finger tips.

The AED is only looking for a shockable rhythm. It is not looking for an AMI or old infarcts.

 

[daedalus]

Im sorry Vent, I do not think I included as much sarcasm as I should. My post was a joke in poor taste. All EKGs should be read by a qualified professional.

 

[VentMedic]

Im sorry Vent, I do not think I included as much sarcasm as I should. My post was a joke in poor taste. All EKGs should be read by a qualified professional.

My apologies too if I came off abrasive.

Slight off track, but it makes a good example.

Recently after STEMI discussions, the LAFD decided to get involved but rather than educate the Paramedics on how to read a 12-lead, they relied strictly on machine interpretation. Needless too say that didn't turn out to well.

http://ems.dhs.lacounty.gov/pdf/FallNewsletter1007.pdf

Of primary concern to the EMS Agency is the false positive .eld
ECG--one which shows a STEMI in the .eld but is not con.rmed
in the Emergency Department. Most SRC’s activate teams of 3-6
people that often respond immediately from home based on the
pre-hospital reading. It doesn’t take too many false activations
to burn out a team or cardiologist. Although the percentage of
false positives has decreased from 44% during the .rst month
to an average of 27% for the subsequent months, reducing and
identifying the reasons for these false positives remains a major
focus of the program.​

Poor tracings are a major contributor to false positive activation:
artifacts or wavy baseline. This can be reduced by ensuring
good electrode placement, reducing patient movement and/or
proper setting of ECG .lters according to manufacturer instructions.
When the paramedic has any suspicion of artifact or irregular
baseline on an ECG reading STEMI, the ECG should
be repeated prior to base contact and/or transport when time
allows. Paramedics should notify the base or the SRC of a tachycardia
or paced rhythm in patients with suspected STEMI.
that our patients are receiving.​

 

[daedalus]

Oh, dont even tell me about it. In Ventura County, the Paramedic is not even allowed to offer an interpretation. They have to go strictly by the interpretations provided by the aging machines.