12 Leads And Analysis

[Just Plain Ruff]

ok, on the life pack 12's how reliable is a 12 lead that prints out after the machine has said noisy signal precludes interpretation. What I mean is if the machine says

"ECG Override: Data quality prohibits interpretation"

how reliable is the 12 lead that is printed out?

I've had a couple of the 12 leads do this.

If there is elevation on a 12 lead like this is the entire 12 lead suspect or is my interpretation of st-elevation and depression valid?

[spenac]

Sometimes by shutting off the ambulance and killing the inverter, etc, so no power is on I have retaken and gotten a better quality. If not I have had to go with what I have. If they have other S/S to match then its probably still accurate to say MI. If not I would say can not rule out MI and treat as possible MI. I have no data as to how accurate the EKG is when you get that advisory. But one extra attempt does not delay transport by more than a minute and might give you more to work with.

[fiznat]

The too noisy for interpretation means that the machine thinks there is too much artifact for the automated analysis to proceed. Usually this means that it is too noisy for you to analyze it also, but sometimes if you get the "artifact- press 12 lead to accept" message and you press the button, you can get a clean looking 12 lead that still says "ECG override/artifact" or whatever at the top. I figure you get this message because the machine WAS seeing a lot of noise before you pressed the button ("to accept"), but then the artifact cleared out and you get a clean strip.

In general I have no problem using any 12 lead that looks clean and has a nice isoelectric line, even if the automatic interpretation had some trouble. Usually I will try and print out another one for confirmation after that (sometimes I get my cleanest print as we're just stopping at the hospital), but for the most part just because the machine thought it was too noisy doesn't mean it actually is.

[WelshMedic]

The too noisy for interpretation means that the machine thinks there is too much artifact for the automated analysis to proceed. Usually this means that it is too noisy for you to analyze it also, but sometimes if you get the "artifact- press 12 lead to accept" message and you press the button, you can get a clean looking 12 lead that still says "ECG override/artifact" or whatever at the top. I figure you get this message because the machine WAS seeing a lot of noise before you pressed the button ("to accept"), but then the artifact cleared out and you get a clean strip.

In general I have no problem using any 12 lead that looks clean and has a nice isoelectric line, even if the automatic interpretation had some trouble. Usually I will try and print out another one for confirmation after that (sometimes I get my cleanest print as we're just stopping at the hospital), but for the most part just because the machine thought it was too noisy doesn't mean it actually is.

I'm guessing that we are talking about the LP12 here, right? It's something that is a recurring problem here too. I find myself overrriding more often than not. For the most part, it doesn't stop you diagnosing STEMI though.

WM

[spenac]

Another thing to check was when was the last time the wires were replaced? They have a short life span. If you are getting it frequently might be time to replace the lead wires.

[Just Plain Ruff]

I think these are the same wires that were initially supplied by LifePak.

Can you give me specifics on how often these wires need to be replaced? I need to take this back to the powers that be.

[spenac]

I think these are the same wires that were initially supplied by LifePak.

Can you give me specifics on how often these wires need to be replaced? I need to take this back to the powers that be.

If I recall when we bought our life Pak 12's we were told 1 year for a busy service and maybe 2 for a slower service. The insulation deteriates and allows for more interference and even the fine wires can break while insulation remains intact. I am not sure where that is in writing though.

[Just Plain Ruff]

I just put in a call to your area representative and hopefully he will call back.

[spenac]

I just put in a call to your area representative and hopefully he will call back.

Please let us know what he says and post if he provides written documentation.

[Monhae]

Remember a big rule in interpreting 12 leads. The machine never interprets. The machine has a series of algorythms it follows based on calculated averages and limited perameters, to make it's interpretations. You have human eyes, common sense and the ability to think outside the box. The reliability of the 12 lead printout is decided on a case by case basis. What you see is the same physical representation of electrical activity as a standard single lead, just less filtered. It uses the same basic electronics to display the waveform. The waveform representation effects the interpretation, but the interpretation algorythms do not effect the waveform displayed. Your evaluation is always the valid one. If you believe that the waveforms printed are to noisy, than run it again. Your the final judge and the final level of validity for the printed strip.

jimmy

Excuse me. A correction. I meant to add that AVL, AVF and AVR are calculated leads and not actual measurements. Those leads should be considered unreliable if there is too much noise or interference.