triemal04 Posted May 23, 2012 Posted May 23, 2012 1. NSR. Probably pericarditis (near global ST-elevation and some PR depression). Could maybe call some of the precordial's hyperacute T-waves, but I'll stick with pericarditis. 2. Sinus arrythmia. Long QT. Inferior and maybe lateral ischemia. 3. 1st degree AV Block. LBBB. Left axis deviation. Basically what the computer said. 4. I will add that number 2 does look a little 'strainy'. A little unusual though given the absence of the large QRS' often found with strain pattern. I was actually looking at this as being more of a right atrial strain pattern. With a 1st degree AV Block and I believe an incomplete RBBB. 5. Maybe some inferior and anterior ischemia but that's pushing it. Looks to be more afib than aflutter. Maybe something exotic like MAT...but I'll stay with afib. And the OP posts on another EMS site with a bit more frequency then here. Or at least with a higher post count.
DwayneEMTP Posted May 23, 2012 Posted May 23, 2012 I'm not sure how I got it in my head that this was Biebs thread. But it's good still! And I'd not been aware that some hospitals had issues with such things...
Kiwiology Posted May 23, 2012 Posted May 23, 2012 (edited) They probably do not, for such a tiny amount of work to crop out the name in Photoshop or Paint it removes the risk of them any problem and in sue happy American that's probably a good thing! Edited May 23, 2012 by Kiwiology
281mustang Posted May 23, 2012 Author Posted May 23, 2012 Tips Remove the name of your hospital from the ECG posting Remove your initials from the ECG before posting Very importantly remove the machine interpretation from the ECG before posting! 1 - ST elevation II, III, aVR, aVF, V4-V6; consistent with inferior ischaemia and ? anterior 2 - Concur with machine interpretation 3 - Concur with machine interpretation 5 - Do not concur with machine interpretation, looks like a poor quality ECG with a lot of artefact, some ST abnormality noted I'll get back to you on 4 I edited out the hospital name in Paint but it appears this forum has a short window for edits? Oh well. And I left the machine interpretation there on purpose, just to screw people up. I'm also a little curious what the OP, who recently posted about finding cadaver intubation sessions, is doing by posting these. What's the motivation? What's the goal? Furthering his/her own education? Perhaps. With only three posts and not a lot of background info it's hard to tell. Perhaps recent events have left me a little jaded. Just trying to further EKG education. I'm really not quite sure what that comment is supposed to imply. Are you suggesting I might be a 'troll' because I'm inquiring about cadaver lab info and EKG interpretations all in the same week? 1
DwayneEMTP Posted May 23, 2012 Posted May 23, 2012 ...Are you suggesting I might be a 'troll' because I'm inquiring about cadaver lab info and EKG interpretations all in the same week? Brother I don't know if that was supposed to be funny or not, but it friggin' cracked me up! "So, you guys identify trolls here by those folks that ask too many medical questions all in a row?" Oh man, I love that.... You're doing fine man. On a regular basis people come here and pretend to be students, or medics, whatever, but are really posting stuff that they got from a dead family member, or their sister that got pissed at the medics that ran on her and are looking for information that might help them in a law suit. Recently we had a chick on here pretending to be a dying 16 year old girl. It's got folks a little bit froggy. If you're a phony I'm guessing that you're lawsuit would look something like, "You know, those fuckers misdiagnosed my mom, and she died! Just look at these ECGs! And before she was even cold they let some kid come in and practice intubating her! The indignity!" My apologies in advance for poking fun if you are a fake and that is actually what happened.... Dwayne
chbare Posted May 23, 2012 Posted May 23, 2012 I am not sure why some people have such an issue with automated interpretations? When we do a XII lead in the field, the interpretation is there. If the OP was going for a true to life scenario, then it's certainly appropriate to leave the interpretation. Not all scenarios have to exist in a world of hyper-reality where we intentionally leave out details that would otherwise exist. 1
paramedicmike Posted May 23, 2012 Posted May 23, 2012 That's true and I agree. However, he's asking us for interpretations. Why bother asking if the interpretation is printed right on the paper? I'm really not quite sure what that comment is supposed to imply. Are you suggesting I might be a 'troll' because I'm inquiring about cadaver lab info and EKG interpretations all in the same week? This is pretty funny and I got a laugh out of it, too. If I was going to call you a troll I wouldn't suggest it. I'd come right out and say it. However, if you read what I actually wrote instead of jumping to all sorts of unfounded conclusions you'd clearly see why I made the comments I made.
Kiwiology Posted May 23, 2012 Posted May 23, 2012 Lets be honest if this was hyper reality the patient would have run away screaming going "I don't want that guy with a funny accent treating me!" My problem with machine interpretation is kind of like cheating or something I dno, I guess it's not really a big deal and I always fold the top of the ECG over so I can't see it while I am interpreting it then I'll look at it
chbare Posted May 24, 2012 Posted May 24, 2012 (edited) As a provider I use all resources I have available. Just as I believe that you need to be capable at quantitative literacy in order to perform correct dosage calculations, I will utilise a guide to double check my work. In addition, I will use the automated interpretation to help me make a decision. Integrating all available information and making decisions based on said information is a cornerstone of what we do in the field. Additionally, allow me be honest. I may not initially pick up on details such as bifascicular versus trifascicular blocks and so on. Many of us talk allot of talk behind the safety of a computer screen and a fabricated situation with no real world consequences. However, In reality, I often have limited amounts of time to make a decision and I do not have the luxury of discussing a XII lead with several other people over the course of several days why we all type away at Google and come off with a warm fuzzy for making the correct interpretation without any help from the machine. Total rubbish to turn away from resources that may provide critical information IMHO. I am one of the biggest offenders of creating scenarios where I have specific learning points in mind where I create hyper-realistic situations where certain types of information are either present or unobtainable because I attempt to guide the scenario toward said learning points. However, in the real world, I will use the resources I have available to help me make the call. Again, I have no issue with a member of this site making the decision to leave the automated interpretation on the XII lead. To be clear, I have no problem with people leaving the interpretion off either, but I will not condone telling people they must remove the automated interpretation. Edited May 24, 2012 by chbare 1
DwayneEMTP Posted May 24, 2012 Posted May 24, 2012 That's true and I agree. However, he's asking us for interpretations. Why bother asking if the interpretation is printed right on the paper?... Because the machines are sometimes wrong. In the LP12 you can turn them off. I always did this at the start of shift secondary to taking a cardiac patient into the ER as a student and joyfully reading the machine interpretation to the 'big room' to find that it wasn't really very close. Not only that, but I knew as soon as I truly looked at the strip that I recognized it immediately and wouldn't have made such a mistake. But of course, I didn't look. Anyway, I think it's a good lesson for folks to learn that they need to use their own brain when possible. Just out of curiosity... Did any of the machine interpretations not match the human diagnosis on the strips? Chbare I certainly see your point but I've rarely, though it's been a few years since I've had to try as I've nothing so fancy here, seen them reliable enough to consider their interpretation. Perhaps your experience is different? I'm just so hinky about 'if it fails once out of 50, then I can't really trust it at all.' But again, the ECG I have now uses clamps on the arms and legs and brass bells with suction cups on them, so think might possibly have changed in the last little while..
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