EKG changes in different leads

[timdog88]

Ok, I searched for this, but couldnt come up with a specific answer...

According to my cardio text, several types of MI's show up on the 12 lead in Leads I and III, in addition to the leads not available on a 3 lead machine. For someone who does not have access to a 12 lead monitor, is it helpful at all to check leads I and III as well as lead II, to see if they indicate a possible MI? I know it will not tell me for sure, and it will only show a change in certain types of MI, but for the types that will show up on lead I and III, is it worth it to check, or just treat based on signs/symptoms?

[medic001918]

Lead II is commonly used as a refrence lead since it shows a great deal about what's going on in the heart. Now, with that being said...there's more than just lead II. A complete view of the heart via 12-lead or modified 12-lead (if you have the capability) is in order for any patient you suspect to be having some form of cardiac event. You should try to view as many leads as possible to form a complete picture of the heart. Even if you can't obtain the complete 12-lead, the more information you have the more informed you are about your patients status.

Don't just think in terms of one lead. Think of the complete picture. This applies not just to an EKG, but in overall patient care.

Shane

NREMT-P

[Just Plain Ruff]

I have never been a fan of trying to diagnose a cardiac event from just 3 leads. Sort of makes it difficult to do unless the monitor is a diagnostic quality monitor.

It's been a while since I've had a 3 lead monitor to use, usually it's the lifepak 12 4 leads.

I have a great CD that if copyright allows, I will post in a rapidshare link for everyone to enjoy. I'll have to check the copyright and see if it's free to share and if it is I'll share.

[paramedicmike]

I'm going to disagree slightly with medic001918's post. Lead II does nothing more than tell you rate and rhythm. That's it. It is commonly used to see what's going on but it doesn't tell you anything other than how fast and the origin of the impulse.

If you want to see what's really happening with the heart, you need a 12 lead (or, for a more complete diagnostic view, go for a 15 lead). The more you can see the better idea you will have as to what's going on in the heart.

If you don't have access to a 12 lead you can do what's called a modified 12 lead. Place your monitor in lead III. Take the red lead and move it to the various positions on the chest where leads would go if you had the 12 lead capability (R then L 4th intercostal space etc...). Make sure you label each one so you know what you're looking at later. This can help provide a better picture with a three lead monitor without the enhancement of 12 lead capabilities.

To answer your question directly, yes. You should be flipping through all three lead readings. If you think you need a better view of what's going on, obtain a 12 lead. If you don't have 12 lead capabilities, use the above to help obtain a modified 12 lead.

Hope this helps.

-be safe.

[Ridryder 911]

I definately agree with Paramedic Mike. For more information I highly suggest Bob Page's Multi- Lead Paramedic and XII Lead Book . Bob (a Paramedic) has been teaching the use of 3 lead system and interpertation for years. It is nicely writtten and detailed enough to understand.

Be safe,

R/R 911

[AZCEP]

Leads II & III are enough to make you suspect an Inferior wall MI. Unfortunately, as was already mentioned, a three lead monitor is set in "monitor" not "diagnostic" mode so the information will be distorted. The information that is gathered should only build on your assessment, performed without the technology. If a patient looks/sounds like they are having an MI, chances are they are.

Use a little clinical judgement and use your tools to help, not hinder you.

[JoelEMT]

Just a note of interest, it may or may not be applicable to you in your area. In Alberta, we are only allowed to interpret lead 2, the only time that we use leads 1 or 3 is when we are @ a DOA to confirm asystole in "2 or more leads".

So for us, jumping to another lead to increase suspicion of MI (Inferior MI the only one that you'd be able to see in leads 1-3 not to mention the previously stated monitor vs diagnostic quality) would more than likely garner some unwelcomed comments from paramedics. Of course, it depends on who your ALS backup is.

[nsmedic393]

I am going to agree with AZCEP. Leads two and three with a diagnostic monitor can cause you to have a high suspicion that the patient is having an inferior wall MI. 1mm of st elevation in two or more leads, right? Most times it should not change your treatment plan just confirm your suspicions.

However (little story here), a little while ago I picked up an elderly lady. She had %100 textbook symptoms of pneumonia. She had been sick for a week. Had fluid in her right lung. Slight SOB. and slight CP while coughing. In my initial assesment vitals were WNL and everything she described about her CP lead me to believe it was not cardiac in origin. Pinpoint CP, only when she took a deep breath or coughed. We had a student that day and I hooked the monitor up and was showing her how diagnostic mode worked and we say st elevation in leads II and III. I immediatly started treating her for cardiac CP we rushed her into the hospital and they thrombolised her a few minutes later.

[Ridryder 911]

I guess Paramedics are no longer taught Mcl1 anymore............

Be safe,

R/R 911

[AZCEP]

There just aren't too many places still using a 3 lead monitor exclusively.

I know, I know, there are many small departments out there that can't afford 12 lead monitors, and are still using 3 leads only. Don't reply telling me how little I know, okay. That aside, the push for 12 lead monitors really limited the use of the MCL leads. Few remember how to do them, much fewer actually do on occasion.