Would you consider it a complete heart block?

[NYMedic828]

Sorry I don't have a strip to show you guys but it's pretty straight forward.

Get called for unconscious, 96 years old. Only history HTN/dementia.

Patient "suddenly" went into an abnormal state as per family.

BP 110/70
HR 80
RR 16
BGL 140 non diabetic.
Painfully responsive.

3/12 get flagged as a complete block by the MRX.

What I saw was a completely regular rhythm, with a slight RSr' presentation and a 1st degree block. The issue is that the PR interval was around 0.3-0.4ms. So my assumption is the P wave was so far from the QRS that the monitor flagged it as being disassociated.

So, would you just consider it a very prolonged 1st degree block or would you say there are two pacemakers firing one superior and one inferior to the AV node? The fact that BP/HR were also fine also read to me as the condition being benign.

We didn't treat anything, the patient was fine by the ER honestly I think it was just standard progressing dementia behavior.?

 

[Christopher]

Sorry I don't have a strip to show you guys but it's pretty straight forward.

Get called for unconscious, 96 years old. Only history HTN/dementia.

Patient "suddenly" went into an abnormal state as per family.

BP 110/70
HR 80
RR 16
BGL 140 non diabetic.
Painfully responsive.

3/12 get flagged as a complete block by the MRX.

What I saw was a completely regular rhythm, with a slight RSr' presentation and a 1st degree block. The issue is that the PR interval was around 0.3-0.4ms. So my assumption is the P wave was so far from the QRS that the monitor flagged it as being disassociated.

So, would you just consider it a very prolonged 1st degree block or would you say there are two pacemakers firing one superior and one inferior to the AV node? The fact that BP/HR were also fine also read to me as the condition being benign.

We didn't treat anything, the patient was fine by the ER honestly I think it was just standard progressing dementia behavior.?

I've seen cases with PRi's longer than that reported, so it isn't unheard of.

CHB would be if you could find evidence that they were unrelated, say a varying PRi. But that would mean you have a brady sinus rhythm blocked from a junc/vent escape rhythm. Seems unlikely.

AV dissociation by default could happen if the P-P was so slow a junc/vent escape kicked in, but given that much "white space" between the P's and Q's, that seems unlikely.

One interesting thing to consider is if the RP was shorter than the PR, it could be retrograde, unless upright in II.

Otherwise, sounds 1AVB.

 

[Veneficus]

I have yet to see a monitor that can diagnose heart blocks with any degree of accuracy.

If you are talking about the Pillips MRx monitor, that is the biggest piece of crap I have ever used.

 

[NYMedic828]

I have yet to see a monitor that can diagnose heart blocks with any degree of accuracy.

If you are talking about the Pillips MRx monitor, that is the biggest piece of crap I have ever used.

It most certainly is a piece of crap.

We are required to transmit anything it flags as a STEMI, it is quite often wrong.

 

[MSDeltaFlt]

Every monitor I've seen regardless of how advanced the technology might be will always have a "save your @ss" circuit. 96 years old with dementia "suddenly went out"? And with those vitals? Benign. Utterly. Grandma probably had a yeast infection or something similar. I'd pay good money if it was anything other than 1°AVB.

 

[abckidsmom]

I have yet to see a monitor that can diagnose heart blocks with any degree of accuracy.

If you are talking about the Pillips MRx monitor, that is the biggest piece of crap I have ever used.

It would make a really good doorstop, except it's so front-heavy that it tips over too easily. Hate it.

 

[RocketMedic]

I'd say a benign 1st degree block.

 

[Brandon O]

What I saw was a completely regular rhythm, with a slight RSr' presentation and a 1st degree block. The issue is that the PR interval was around 0.3-0.4ms. So my assumption is the P wave was so far from the QRS that the monitor flagged it as being disassociated.

Wide or narrow QRS?

 

[hoop762]

Even while being completely inaccurate in terms of interpretation, I find our mrx to be more reliable than our lp12. Don't have any experience with any other monitors.

The lp12 game me 3 different incorrect 12 lead interpretations taken 1 minute apart on the same pt.

Atleast the mrx gave me the same wrong interpretation 3 times.

Don't have strips, so here's you're grain of salt (.)

 

[NYMedic828]

Just to be clear.

We did NOT think it was a 3rd degree blockage. I am just curious if we were wrong, based on the monitor diagnosis for some reason or another.

QRS was narrow, also probably puts blockage on the side. Slight RSr' pattern but nothing major.

My assumption was the family is just not keeping up with the progression of her age/dementiated condition so they considered her to suddenly be acting strange. Shes 96... (for the record it came in as an arrest :wacko

Vitals suggested absolutely nothing wrong in the form of a cardiac condition. No reason to suspect stroke. No reason to suspect hypoglycemia/sepsis.

The sole purpose of this thread was to be certain there isn't some strange criteria I don't know about for complete heart blocks.

 

[Brandon O]

QRS was narrow, also probably puts blockage on the side. Slight RSr' pattern but nothing major.

With consistently-associated P waves, regular rate, and a narrow complex, I think it speaks for itself. Unless (not having the strip to look at) what you saw as P waves were perhaps U (or even T) waves, but that's a stretch.

 

[BandageBrigade]

Why all the hate for the MRx? Lots of options, nice large screen. I've found it to be just as reliable as the other popular options out there. Have those hating on it spent more than a few shifts using it?

 

[abckidsmom]

Why all the hate for the MRx? Lots of options, nice large screen. I've found it to be just as reliable as the other popular options out there. Have those hating on it spent more than a few shifts using it?

I've been using it for a year now, and sometimes get on a volunteer truck that has a LP 12. It's the constant alarming, difficulty in setting intervals for vital signs, nebulous code summaries, stupidly placed EtCO2 port, in-depth user-driven multistep operational test, difficult to adjust EKG gain, and that's just a quick brainstorm.

It doesn't begin to compare with physiocontrol's machines, from a practical standpoint. I don't know about the code inside, but people who've told me about that tell me that phillips has the worst of that.

 

[NYMedic828]

Things I like about the MRX

Running 12 lead.
Large storage pouches.

Things I hate about the MRX
QCPR analyzer (what a joke)
No built in RAD-57
PIA user test with test load nonsense.
It's a pain to reach the ETCo2 port.
No push dial. I have to input patient name age sex and pcr number on every ECG. Having to press the button down 25 times to get to Z and then back to A another 25 pressed, SUCKS.
It alarms for EVERYTHING. I don't need it to sound like a telemetry unit in the patients house/back of the ambulance all the time.
It diagnoses everything when it really is nothing. I look at an ECG, textbook picture in a 20 year old and it spits back LAE, prolonged QT, old anterior infarction.

Everything I hate on the MRX is perfected in the LP-15. All it is missing is a running 12.

 

[Veneficus]

Why all the hate for the MRx? Lots of options, nice large screen. I've found it to be just as reliable as the other popular options out there. Have those hating on it spent more than a few shifts using it?

One of the places I worked was a testing center for Phillips. I have spent years with it.

It is garbage in my opinion. The only thing I think it good for is anchoring a boat.

From the pulse-ox cables, to the alarms, to the filtering software, I can find no redeeming feature that isn't done better by somebody else.

 

[Christopher]

No built in RAD-57.

This is a good thing...the RAD-57 doesn't work.

It's a pain to reach the ETCo2 port.

Agreed. The LP12/LP15 have it in a very convenient location.

No push dial. I have to input patient name age sex and pcr number on every ECG. Having to press the button down 25 times to get to Z and then back to A another 25 pressed, SUCKS.

It's just as awful on every monitor I've ever used...so why bother? You have a pen you could use to write on it

It alarms for EVERYTHING. I don't need it to sound like a telemetry unit in the patients house/back of the ambulance all the time.

Turn off the alarms? We've done that on ours (MRx and Zoll's) and don't have this problem. Don't blame the monitor for your service's configuration faults.

It diagnoses everything when it really is nothing. I look at an ECG, textbook picture in a 20 year old and it spits back LAE, prolonged QT, old anterior infarction.

There is not a single computerized interpretation out there that is worth a damn in the long run. The DXL is roughly on par with GE Marquette's 12SL and the newer Glasgow algorithm that PhysioControl is using (I don't have enough experience with Innovise that Zoll is using yet).

If you rely on anything but its calculations of intervals, you'll be sorry.

Everything I hate on the MRX is perfected in the LP-15. All it is missing is a running 12.

The LP-15 is a touched up LP-12...they really don't offer much in the way of improvement. The CPR feedback features are just as bad as the Q-CPR features on the MRx.

I put the LP-12 behind the MRx, and the LP-15 and the MRx roughly tied. If the MRx had a bigger printer I'd probably favor the MRx over the 15. The Zoll E- and M- series are the worst monitors on the market and the X-Series is currently my favorite, although the side printer is not friendly at all.

Our cardiac monitors are uniformly bad and poorly configured ones are worse.

 

[Veneficus]

The LP-15 is a touched up LP-12...they really don't offer much in the way of improvement.

.

I really like the LP12, but this is the best description of the 15 I have ever heard.

 

[Christopher]

.

I really like the LP12, but this is the best description of the 15 I have ever heard.

HD Technicolor and a big *** printer, if only I could watch Netflix on it.

 

[clearblueskies]

I would say no

I would say with the information that you provided that this more than likely would not be a complete heart block. Of course there is no way for me to say exactly without having the 12 lead in front of me. The true moral of this story is that 12 lead interpretation on ANY monitor is USELESS, and should not even be set up to print with the actual rhythm tracings. The reason for this is it allows SOME medics the opportunity to be lazy and less efficient at 12 lead interpretation. I have seen it a ton of time in many different systems, where the medic would take the time to do a 12 lead and then just quickly glance at what the interpretation, instead of actually reading it. It is for this reason that our new monitor in on our aircraft DO NOT even come equipped with the interpretation function on the 12 leads. The company rep actually told us that they expected if the person operating the monitor was doing a 12 lead, then they should be able to READ and INTERPRET it themselves. But all in all I would say that the symptomatology, vital signs and ekg information that you gave, does not lead me to believe it was a 3rd degree block.

 

[VFlutter]

We use the term "marked 1st degree AVB" for PRI above .30 , it is. It is not all that uncommon on our cardiac floor. That does not mean the P wave is disassociated. I actually asked a cardiologist that question before about the cut off at which you would consider a PRI too long to be associated, I never got a definitive number.


This is highly unlikely but worth mentioning...some patients can have what is called isorhtymic Disassociation in which the Atrial and Ventricular rate are relatively the same. This will result in runs of what appears to be a normal P-QRS relationship but if you look at it over time (a minute or two) you will see the PR slowly decrease until the P wave fuses into the QRS, back out, into the T wave, and then progresses back into a normalish appearance. So the strip you print out may appear totally normal. This usually happens when there is a high junctional escape so the rate and QRS do not stand out. I have only seen this once so I think it is rare. Hopefully I explained it right.