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

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Comments
Stuart
Anterior T wave inversions and PE.
Studies (can't remember them off the top of my head) have shown that TWI in V1-4 + III is 85% likely to be RV strain, 15% ischemia. If I see anterior TWI, the very next lead I look to is III
2014-11-23 18:00:51
Arlene R
The Trouble with Sinus Tachycardia
It has been very insightful for me as i read this post. Thanks to the may people who commented. Like many nurses, I was also taught to differentiate svt from st by rate and now I stand corrected. I have a Telemetry test coming up soon, I wont have the patient in front of me…
2014-11-20 19:59:33
Nick
100 yof CC: Rib pain and intermittent spasms
Can't be a potassium imbalance. The TW's wouldn't change and then change back. If it was coronary spasm, I would expect some ST segment elevation. The TW'S are also not hyperacute (peaked). Does she wear some sort of electronic stimulator?
2014-11-19 01:05:43
Anterior T wave inversions and PE. | EMS 12 Lead
Not just S1Q3T3: Look at the other 10 leads!
[…] Last week, I described the case of a middle-aged male with a vague history of heart failure who had been having progressive shortness of breath for 4-5 days. On the day he called 911, he had been walking a short distance when he syncoped. EMS obtained an ECG: […]
2014-11-18 18:33:47
Christine
100 yof CC: Rib pain and intermittent spasms
I believe this may be coronary artery vasospasm.
2014-11-18 11:02:45

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