Why are we still interpreting cardiac rhythms?

E tank said:
Wouldn't matter if you could...
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I disagree. If I could check troponin levels, I could use that to help paint a clinical image in combination with patient presentation and the ECG. Also, it could be used as an intial measurement in delta trops, which doesn't help me, but does help the patient.
 
NPO said:
I disagree. If I could check troponin levels, I could use that to help paint a clinical image in combination with patient presentation and the ECG. Also, it could be used as an intial measurement in delta trops, which doesn't help me, but does help the patient.
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would you base where you brought the patient if you could measure troponin?
 
E tank said:
would you base where you brought the patient if you could measure troponin?
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Probably not. That's not the question I was answering. I was answering your point that it doesn't matter if we check trops.
 
NPO said:
Probably not. That's not the question I was answering. I was answering your point that it doesn't matter if we check trops.
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I think he was referring to destination and treatment plans.
 
CALEMT said:
I think he was referring to destination and treatment plans.
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I think so too, which makes sense since that's where the line of conversation was going. I was just commenting that there isn't no point at all.
 
NPO said:
I think so too, which makes sense since that's where the line of conversation was going. I was just commenting that there isn't no point at all.
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No point? In our current County, we have seen an influx in patients being transported to non Cardiac facilities. Transports where paramedics have trop. Results from clinics. For example Kaiser.
Then they have to get transferred out once again to a hospital that has Cath Lab capabilities. Which could have been avoided if Paramedics had basic training on basic labs.
I don’t see how Trop. Levels would be useless.
 
NPO said:
Probably not. That's not the question I was answering. I was answering your point that it doesn't matter if we check trops.
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The best determination of what treatment the patient needs (and by extension, where) is the whole purpose of EMS. Nothing else does matter. What do you mean by "helps the patient"? Benefit is a very broad category that requires randomized control trials to determine.
 
wtferick said:
No point? In our current County, we have seen an influx in patients being transported to non Cardiac facilities. Transports where paramedics have trop. Results from clinics. For example Kaiser.
Then they have to get transferred out once again to a hospital that has Cath Lab capabilities. Which could have been avoided if Paramedics had basic training on basic labs.
I don’t see how Trop. Levels would be useless.
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Ok, fine. You run a POC troponin and it comes back normal. Now what?
 
E tank said:
Ok, fine. You run a POC troponin and it comes back normal. Now what?
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Then you run your show as you please.
What if it comes back high/abnormal? Seems to me that many disregard the result, and get hospital staff annoyed/ticked.
 
E tank said:
What do you mean by "helps the patient"? Benefit is a very broad category that requires randomized control trials to determine.
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They're going to run delta trops in the ER. The sooner that is complete, the sooner they can get a useable clinical result, reduce LOS, and speed up the process. No randomized controlled trials needed to know that the less time a patient has to spend waiting in the ER, the better.
 
wtferick said:
Then you run your show as you please.
What if it comes back high/abnormal? Seems to me that many disregard the result, and get hospital staff annoyed/ticked.
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You'll have to tell me....can NSTEMI's go to any hospital where you are? Because you could be home from your shift before your patient's troponin bumped. There is a long list of non-cardiac causes of troponin elevation too. As far as hospital staff getting ticked off...at the ambulance crews? For misinterpreting a hospital based biomarker test? I'm definitely missing something there.
 
NPO said:
They're going to run delta trops in the ER. The sooner that is complete, the sooner they can get a useable clinical result, reduce LOS, and speed up the process. No randomized controlled trials needed to know that the less time a patient has to spend waiting in the ER, the better.
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So how do you determine a "useable" clinical result (as opposed to an un-useable?) Are they going to use your POC instrument? Is it a high sensitivity test? Does the hospital use a different assay? Way more to the issue than good intentions and what may seem like common sense. You get normal levels and transport accordingly. The non-PCI capable hospital you bring them to follows the cTn for the next 8-16 hours then transfers for NSTEMI. What have you accomplished?
 
E tank said:
You'll have to tell me....can NSTEMI's go to any hospital where you are? Because you could be home from your shift before your patient's troponin bumped. There is a long list of non-cardiac causes of troponin elevation too. As far as hospital staff getting ticked off...at the ambulance crews? For misinterpreting a hospital based biomarker test? I'm definitely missing something there.
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I think you missed the point at the first post.
 
to go back to the OP, monitors have issues: They need people to remind them that the patient isn't isn't dead when it thinks they are.
 
wtferick said:
My apologies. I should have been more specific. Turns out many Paramedics have no clue what troponin is. 🤯
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Troponin leak from kidney issues, fluid overload or missed dialysis. Yeah bud, never required a stemi/heart center/cath lab to fix those for my dad.
 
johnrsemt said:
to go back to the OP, monitors have issues: They need people to remind them that the patient isn't isn't dead when it thinks they are.
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I get it, but why is this the case in 2021? Is reliably interpreting cardiac rhythms really that difficult with all of the technology we have?
 
This is less a tech question than a risk management question, I think. For example, taking Physio-Control's 2009 documentation as a reference point...do we think it is OK that the algorithm misses nearly 20% of AMI? Is that an appropriate level of risk to take? I don't know - I would say no, but that's a gut response. On a system level, is that right? Do you need a clinician to interpret? Probably.

I have to keep digging on recent research though.

I will say, it looks like even EPs don't have great accuracy at reading ECGs, but it seems close to paramedic read quality.
 
I'd think within the next decade as AI and machine learning continue to improve, we'll see all computer/AI interpertation.
 
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