12 Lead EKG Analysis

[cfaulknor]

When looking at a 12 lead EKG, do you guys check for these things? If so, what do you do with the information?

-Chamber Enlargement

-Axis Deviation

-Bundle Branch Block

-Infarct/Ischemia (hopefully goes without saying)

Is there a use in screening for things like enlargement, axis, etc. prehospital? what do you guys think?

[AZCEP]

Chamber enlargement can give you an idea of other disease progression.

Axis Deviation can also provide information related to other disease states. COPD is especially evident from axis deviations. It will also allow for origins of the electrical activity that you see.

Bundle Branch Block tends to be overemphasized, but intra-ventricular and intra-nodal conduction delays are useful to specifically look for.

Infarct/Ischemia of the acute variety tends to cement a working presentation, but when patients present with evidence of previous events I tend to look deeper.

Yes, the 12 lead is a useful tool for many things beside the acute infarct/injury pattern.

[chbare]

Looking for the actual cause of a BBB will give you more information than simply identifying that on exists. (identification of a fascicular block that is causing the BBB for example)

Axis determination is actually quite useful. It can help us identify possible disease pathologies and even assist in the identification of certain conduction problems. (A well known example would include looking for right shoulder axis deviation when we are faced with a SVT vs. V-tach scenario.)

Take care,

chbare.

[fiznat]

I like to do a lot of that stuff with 12 leads. As others have mentioned, mean axis is really one of the most useful "extra" things to know, as this can be extremely helpful in diagnosing rhythm origin, as well as possible strain/hypertrophy patterns that could be useful as well.

Ischemia/infarct really goes without saying, while chamber enlargement is something I usually notice later on when I review the ECG. Bundle branches I watch out for, as they can confound ST elevation findings and screw up axis readings, but beyond that I dont use them all that much as far as identifying pathology.

One of the things I am really trying to get better at is evaluating all of these characteristics more quickly. I know what to look for by now, but it takes me much longer than I'd like. I want to be able to look at an ECG quickly in the middle of a call and be able to rapidly identify subtle yet key changes. I can find injury patterns fairly quickly, but sometimes I find myself needing to think a little bit longer when assimilating all the axis, rotation, hypertrophy, etc information.

With time and practice, I suppose.

[bozzie22]

ST elevation, ST depression, Inverted T Waves, check V1 for a BBB, etc

[scott33]

ST elevation, ST depression, Inverted T Waves, check V1 for a BBB, etc

Same here, plus I, II, and III for axis.

[CBEMT]

"Does this 12-lead change my destination."

[Dustdevil]

"Does this 12-lead change my destination."

Yep.

And more important than that, it changes whether I give an inappropriate medication to somebody.

[PJLong]

"Does this 12-lead change my destination."

Yes not all hospitals are emergent cath hospitals. In Atlanta, of the 15 or so area hospitals only 5 are able to take pts directly (or almost directly) to the cath lab. You wouldn't take a trauma pt to a nontrauma center you should not take a cardiac pt to a non trauma pt. And just because a hospital has a cath lab does not mean the can get a pt right in

[PJLong]

Yep.

And more important than that, it changes whether I give an inappropriate medication to somebody.

Regardless of the 12 lead unless you have the ability to check cardiac enzymes on your truck all chest pain should be treated as cardiac related. You would not withhold oxygen from a asthma pt with obvious diff breathing that had a saO2 of 100%.