12 leads: where do you feel weak?

[fiznat]

I'm thinking about doing an "advanced 12 lead" class at my service, and I was hoping I could get some information from you all to get me started.

How in depth do you get when you read a 12 lead? Do you look at just the STEMI signs, or do you go as far as axis, rotation, hypertrophy, and the syndromes? How about electrolyte disorders, pulmonary complications and strain patterns?

Please be honest: how deep is your 12 lead knowledge, how often do you use it on routine patients, and how comfortable do you feel with your understanding? What would you like to know more about, or get more practice with?

Thanks guys!

[spenac]

Some say I perform to many 12 leads. But if I feel they need a 3 lead hooked up why not take a more complete look. It is a valuable part of my diagnostic tools.

I do try and look beyond STEMI, though that is my first glance and can be caught often in less than 10 seconds. I like to look at all the information presented. Yes I realize some of the things I read on them will not change out of hospital care but as a student and a healthcare professional I think it is important to be able to learn as much as I can. I like to see if I can identify electrolyte imbalances, respiratory problems, etc and run a new 12 lead when we stop at the hospital to see if my choice of treatment has began to correct the problem.

I still am learning and at times doctors point out where I misinterpeted something, yes I try if the ER is slow to pick the doctors brain.

[fiznat]

Okay I'll be more specific:

1. Do you routinely determine the mean QRS Axis and can you apply that information practically?

2. Are you aware of the Sgarbossa Criteria and have you used it before?

3. Do you routinely check for Cor (or P) Pulmonale?

4. Do you look for LVH, BER, and BBB on every STEMI?

5. Do you systematically interpret every 12 lead you read in the same order every time?

6. How familiar are you with syndromes like Brugada, Pericarditis, Wellen's, WPW, hyper/hypo K, and long QT?

Others....?

[spenac]

Well as a student and based on your questions I have more to learn . Yes I want to know more.

Eagerly waiting more education.

Sincerely,

Grasshopper

One of the biggest problems I find is that while I intend to start off and follow same order I will get distracted by something I spot. And that then delays my interpetation because sometimes I have to start over. Yes I'm still slow.

Sgarbossa Criteria is determining MI in LBBB but is still not a 100% if I recall correctly.

So OK I need more 12 lead eduaction. First step is admitting the problem.

[chbare]

This is the typical pattern I follow when I look at any XII lead:

Rate:

Rhythm:

P for every QRS:

QRS:

PRI:

QTc:

Axis Deviation:

Q waves:

Localized Changes:

II, III, AVF:

V1, V2:

V3, V4:

V5, V6, I, AVL:

Right Ventricle:

Posterior:

Additional Notes:

Impression:

Take care,

chbare.

[spenac]

Localized Changes:

chbare.

What are you meaning with term "Localized Changes"? When you explain it will probably be something I call by different term. Thanks.

[chbare]

I mean looking at lead groups for "localized changes." For example, II, III, AVF changes would be localized to the inferior wall.

Take care,

chbare.

[spenac]

I mean looking at lead groups for "localized changes." For example, II, III, AVF changes would be localized to the inferior wall.

Take care,

chbare.

Now I got you. Thanks for that clarification. Still a student so some terms still get lost in the jumble of my brain.

[akroeze]

Okay I'll be more specific:

1. Do you routinely determine the mean QRS Axis and can you apply that information practically? No, something I have been meaning to learn but have a hard time grasping unfortunately

2. Are you aware of the Sgarbossa Criteria and have you used it before? Sounds very vaguely familiar, something I'm going to have to google

3. Do you routinely check for Cor (or P) Pulmonale?Yes

4. Do you look for LVH, BER, and BBB on every STEMI?Yes

5. Do you systematically interpret every 12 lead you read in the same order every time?I try to as much as possible but get distracted very... oh look a kitty!

6. How familiar are you with syndromes like Brugada, Pericarditis, Wellen's, WPW, hyper/hypo K, and long QT?Familiar enough with all those except Wellen's.... never heard of it, another thing to google

Others....?

My answers in red above.

[scott33]

1. Do you routinely determine the mean QRS Axis and can you apply that information practically? Yes, I usually determine it, as I use the easy-peasy Bob Page way, but don't always document the info it as it can mean many different things, including nothing at all.

2. Are you aware of the Sgarbossa Criteria and have you used it before? I know what it is, but haven't learned how to apply it from memory. LBBBs will still get fast tracked to STEMI centers as a R/O MI in many places

3. Do you routinely check for Cor (or P) Pulmonale? Yes, I find the right side of the heart far more interesting

4. Do you look for LVH, BER, and BBB on every STEMI? No

5. Do you systematically interpret every 12 lead you read in the same order every time? No, poor practice on my part.

6. How familiar are you with syndromes like Brugada, Pericarditis, Wellen's, WPW, hyper/hypo K, and long QT? Familiar enough to spot it on a good 12-lead trace as they have pretty unique morphologies. That is, with the exception of Wellens. Never heard of it.

Others....?

I always look at right side with inferior wall involvement by moving V4 to V4R.

Usually like to see what part of heart was affected, with those who state they have had an MI in the past. Just for the hell of it.

Always tell myself to look out for S1, Q3, T3 with any sudden onset of SOB... and always forget.

Have been guilty of looking at the cool stuff before the underlying rhythm