Paramedics Pride Themselves on ECG Interpretation


 
 

Steve Berry | From the January 2012 Issue | Sunday, January 1, 2012


Paramedic: I call it a wandering arterial pacer with variable conduction and bundle branch block.
Another Paramedic: Nah, it’s a Mobitz type II below the AV junction with occasional PACs encased in a left ventricle that’s obviously hypertrophied.

Another Paramedic on Scene: No way. It’s an AV dissociation with a tattering of atrial escape beats.

(Sigh) Yet Another Paramedic: Fugitaboudit. It’s a 2:1 Wenckeback with a few aberrantly conducted PJCs added in for flavor.

EMT-B: I call it pulseless and apneic!

ECG interpretation is an integral part of being an ALS provider. A paramedic needs to acquire this skill—specifically 12-lead ECG acquisition—if they are to ever turf off the exhausting procedural process of CPR to EMSers unqualified to just stand there on scene like them, staring at tracings of asystole.

On my first day as a raw EMT—back when LIFEPAK 5 cardiac monitors, limited to three leads, were the standard—my paramedic partner, during the obligatory phase of shaking hands, threw a book at me.

“Memorize this book on basic ECG interpretation by the end of the week.”

“No problem,” I squeaked meekly.

Thus began my journey into ECG interpretation. From day one, squiggly, burned tracings were thrust into my face with the thrustee demanding to know what each PQRSTU wave was communicating. PQRSTU, by the way, is also my acronym for Paramedic Quantum Renal Seepage Tracking Utensil. Lasix’s got nothing when it comes to creating incontinence like that of misinterpreting an ECG strip in front of your peers or an ED doc—much less the patient.

Just when I was starting to feel good about my three-lead interpretation skills, a radical paramedic instructor by the name of Mike Taigman came down from Denver and told us at an EMS in-service, “Behold, my children of cardiology, for I bring you tidings of great joy. For unto you, this day is born an electrode. Tis MCL1.”

“Shut the front door,” I bemoaned to myself. OK, those weren’t the exact words. But I gotta tell ya, I wasn’t happy. Selfishly I thought, “Hold your Ps and Qs there big guy. You’re talking about more accountability for the same pay?”

You know who was even more perturbed? ED docs. “These medics are getting out of control,” they’d say. “Before you know it, they’re going to want to paralyze combative patients prior to intubation.”

“Ha! Ha! Ha!” we would say. “Like that would ever … Hmmm that’s not such a bad idea.”

A medic can always date themselves by the LIFEPAK monitor’s model number around at the time. As the number increased from LP-3 to LP-10, to LP-12, to LP-15, more electrodes began to appear on the patient. I can’t wait until the LP-350 comes along. Regrettably, by then, medics will be using it on me.

What I still find irritating is that no matter how well our ECG decoding skills have developed over the years, some patients out there still fail to agree with my diagnostic ECG findings as to whether their cardiac event is indeed cardiac in nature.

“Mr. Smith, I don’t find any significant findings on your 12-lead, so stop your whini … What’s that you said Mr. Smith? I can’t hear you between your agonal respirations.”

We, as paramedics, tend to look for zebras more often than horses when we hear hoof beats. This is the standard line used on those clairvoyant ECG types who always believe the worst possible catastrophic cardiac event is about to unfold every time they encircle a patient’s chest with self-entangled electrical wiring.

It’s no wonder, seeing as how every cardiology instructor savors the opportunity to trick their students by always having a serious cardiac event hidden in ECG strips that flashes across the PowerPoint screen.

From a self-esteem point of view, I can appreciate how medics take pleasure in the prestige their ECG interpretation skills have given them. There’s something about commanding a scene where everyone on your squad gives dramatic pause during their patient care as they anxiously wait for you to divulge the secret hidden within those squiggly lines. Unless, of course, the EMT suddenly takes the 12-lead from your analyzing hands and turns it right side up for you to read.

On a serious note, I want to take this opportunity to give tribute to all those paramedics, docs and nurses who have advocated the need for advanced electrocardiography in the prehospital setting.

For that, I sing your praises from the top of my R wave to the bottom of my Q wave … Wait, scratch the Q wave and make that an S wave.

Until next time, keep a poker face while reading ECGs—unless you see zebras. Then play stripe poker. JEMS

This article originally appeared in January 2012 JEMS as “Rite of P-Wave Passage: The art of interpreting the ECG.”




Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Administration and Leadership, Steve Berry, Jems Lighter Side

Author Thumb

Steve Berryhas been a paramedic for the past 25 years in the southern Colorado region. He's the author of the cartoon book series I'm Not An Ambulance Driver. Visit his Web site at www.iamnotanambulancedriver.com to purchase his books or CDs.

BROWSE FULL BIO & ARTICLES >

What's Your Take? Comment Now ...

Featured Careers & Jobs in EMS





 

Get JEMS in Your Inbox

 

Fire EMS Blogs


Blogger Browser

Today's Featured Posts

 

EMS Airway Clinic

Simulation-Based Assessment Facilitates Learning & Enhances Clinical Judgment

Simulation is an educational tool that can be used to develop and refine clinical skills of the student in a controlled environment before they progress to becoming practicing clinicians.
More >

Multimedia Thumb

Buffalo Medics, Firefighter Keep Working in Crash

Rural Metro medics describe crash that overturned their ambulance.
Watch It >


Multimedia Thumb

Drone Delays Landing of Ohio Medical Helicopter

Miami Valley Hospital incident raises questions over legalities of drones.
Watch It >


Multimedia Thumb

Four Killed in New Mexico Medical Plane Crash

Crash near fairgrounds claims patient and crew of three.
Watch It >


Multimedia Thumb

Texas Ambulance Involved in Crash

Odessa ambulance and car collide during response.
Watch It >


Multimedia Thumb

Building Explosion, Collapse in Paris Suburb

Death toll rises to eight after blast in Rosny-sous-Bois.
More >


Multimedia Thumb

New Mexico Air Ambulance Crash

NTSB investigates crash that killed four.
More >


Multimedia Thumb

Where in the World of EMS is A.J.? Scranton

JEMS Editor-in-Chief visits his hometown of Scranton, Pa.
More >


Multimedia Thumb

LMA MAD Nasal™

Needle-free intranasal drug delivery.
Watch It >


Multimedia Thumb

Braun Ambulances' EZ Door Forward

Helps to create a safer ambulance module.
Watch It >


Multimedia Thumb

VividTrac offered by Vivid Medical - EMS Today 2013

VividTrac, affordable high performance video intubation device.
Watch It >


More Product Videos >