EMS 12-Lead: Triaging Triage ECGs

I’ve spent nine years working in an emergency department, which means I’ve also spent nine years performing electrocardiograms at triage. With a couple thousand waiting-room ECGs under my belt, I’ve noticed a few things:

  • A lot of ECGs are ordered at triage.
  • Many of them are performed on low-risk patients.
  • Very few of those ECGs lead to a change in initial management.

Oh, and one more thing:

  • Most physicians hate signing triage ECGs.

I can’t say I blame them. Triage ECGs interrupt their workflow and, worse than just slowing them down, that distraction can lead to errors. As an additional frustration, these patients often end up being seen by a different doctor in the department, and no one likes making diagnostic or treatment decisions that another provider will have to deal with. Plus, if the signing physician does happen to find something wrong, there’s always a nagging concern that the patient will end up being added to their already full group and need to be seen immediately—further interrupting flow.

Triage ECGs bring work and distraction.

So it’s understandable why many emergency physicians are rejoicing at the publication of a new study by Hughes, Lewis, Katz, and Jones: “Safety of Computer Interpretation of Normal Triage Electrocardiograms” [1].

To see a bunch of ECGs from my collection that show acute MIs but were read as normal by the computer, follow this link or click on the tracing above.

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EMS 12-Lead: ECG Mixtape – Vol. 2

Welcome to the second installment in our ECG Mixtape series! It looks like this will be an irregular publication while we streamline our process of picking cases and getting permission to reproduce them. Enjoy!

Pick of the Week

This weeks top pick comes from cardiologist Dr. Gianni Manzo in São Paulo, Brazil, who shared this case on the Figure 1 app [note: the app and site require free registration to view cases].

A 78 year old male presented with a chief complaint of “oppressive” chest pain. The patient’s past cardiac history was significant for coronary artery bypass graft (CABG) surgery and pacemaker. The following ECG was obtained on arrival.

It shows an AV-sequential paced rhythm at approximately 70 bpm (probably a DDDR pacemaker). Most folks would just end their interpretation there (and the machine certainly will), but there’s a lot more to see on this tracing… like an infero-posterior STEMI!

For the rest of the discussion of this ECG, or to see the other tracings featured in our mixtape, follow this link or click on the ECG above.

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EMS 12-Lead: ECG Mixtape – Vol. 1

Welcome to the start of a new series here at EMS 12-Lead. With the ECG Mixtapes we’ll compile some of the week’s best ECG’s from around the world of social media and #FOAMed. As High Fidelity taught us, “The making of a great compilation tape, like breaking up, is hard to do and takes ages longer than it may seem.” Please dig deeper into the cases that interest you.

Pick of the Week

This week’s top pick comes from Mohd Faried over at the EKG Club on Facebook.

The patient, a 58 year old female, presented with chest pain x 1 hour with diaphoresis and signs of heart failure. This ECG shows sinus tachycardia, a (presumed) new RBBB, severe ST-depression in the inferior leads, and towering ST-elevation in aVR—which add up to quite a poor prognosis. It is important not to mistake the profound ST-changes in the limb leads for an extremely wide QRS (> 240 ms); the QRS in this tracing is really about 170 ms.

For the rest of the discussion of this ECG, or to see the other tracings featured in out mixtape, follow this link or click the ECG above.

The post EMS 12-Lead: ECG Mixtape – Vol. 1 appeared first on The Medial Approach.