McLearning and 12-Lead ECG interpretation

I’ve been giving a lot of thought lately to paramedic education and the problem of 12-lead ECG interpretation.

Specifically, the reasons why paramedics aren’t taught to actually read a 12-lead ECG and are instead given a crash course in “STEMI recognition” which does not prepare the student to differentiate between the ST-elevation of acute STEMI and other causes of ST-elevation.

This TED Talk by Dan Meyer about high school math education struck a chord with me. I highly recommend the entire talk, but the most relevant part for this discussion starts at 01:50.

[youtube=http://www.youtube.com/watch?v=NWUFjb8w9Ps?fs=1]

Here’s the part that really resonated with me:

“David Milch, creator of Deadwood and other amazing TV shows [...] swore off creating contemporary drama — shows set in the present day — because he saw that when people filled their minds with 4 hours a day of, for example, 2 1/2 Men, it shapes the neuro-pathways in such a way that they expect simple problems. He called it an “impatience with irresolution”. You’re impatient with things that don’t resolve quickly. You expect sitcom-sized problems that wrap up in 22 minutes, 3 commercial breaks and a laugh track.

I’ll put it to all of you — what you already know. No problem worth solving is that simple.”

Doesn’t that exactly describe the paramedic approach to 12-lead ECG interpretation?

EKGs for Dummies, 12-Leads Made Easy, Rapid STEMI ID, etc. etc. etc.

Just the “need to know” information without all the difficulty of axis determination, bundle branch blocks, electrolyte derangements, differential diagnosis of tachycardias, primary and secondary ST-T wave abnormalities, identifying acute STEMI in the presence of STE-mimics, and other things that we have no patience for because we can’t learn it in 22 minutes.

As if we can jump straight to the finish line and enjoy the fruits of victory without ever preparing for the race.

The problem is compounded by policy makers who “don’t know what they don’t know” (thank you Don Rumsfeld). They consider it a foregone conclusion that comprehensive 12-lead ECG knowledge is not practical for paramedics.

I say that it’s indispensable.

4 Comments

  • G.W. says:

    I love that Rumsfeld quote. I have adapted it to my own, "sometimes it is better to know what you don't know than to know what you know."

  • Tom B says:

    I like it, GW! Socrates would agree with you.

    Tom

  • resq93 says:

    I would love to take an advanced 12 lead course. As you said, most courses and educators only teach STEMI recognition – the course i’m probably looking for is only given in medical schools. Let me know when you put a lecture up! I’ve read and reread the books by Dr Garcia which are really good, but there is really is no substitue for a good course.

  • Anonymous says:

    I really like Garcia and Holtz! Good stuff. You’d probably really enjoy my 3-day comprehensive 12-lead ECG course.

    Tom

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation
Comments
Al
“Bad heartburn” – 82 y.o. female without chest pain.
oh I forgot one more thing, where are the P waves ?? hard to see on this phone but is it junctional or a block ?? If it's a heart block then there is more evidence of ischaemia to the Node. ...... which is isn't good.....
2014-08-21 12:59:09
Al
“Bad heartburn” – 82 y.o. female without chest pain.
Good treatment by all. Well done Jessica for being the first. .... I would use morphine instead of fentanyl due to BP dump and future use of amiodarone but very small doses 1-2 mg. Two good reasons two steer clear of GTN 1. Inferior AMI 2. HR 40. Both Will reposition the Pt on the…
2014-08-21 12:29:43
Dan
“Bad heartburn” – 82 y.o. female without chest pain.
I'm on board with most of the convents so far. No need to elaborate. I would add maybe a dissection into the aortic root causing RCA occlusion. Not going to know without imaging. Call cath from the field regardless.
2014-08-21 07:41:17
Dan August
“Bad heartburn” – 82 y.o. female without chest pain.
Correction S* and T wave.
2014-08-21 01:53:14
Dan August
“Bad heartburn” – 82 y.o. female without chest pain.
ST elevation in all leads is caused by early repolarization. That's why the Q and T are mashed together. Could be a stemi, but you can't tell with this going on.
2014-08-21 01:51:45

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