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 (e.g., EKGs for Dummies, 12-Leads Made Easy, Rapid STEMI ID, 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.

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
Matt King
59 Year Old Male: Unwell
This is A-Fib(irregularly irregular) with aberrancy(RBBB) coupled with a STEMI. There is ST elevation in lead I, avL, v4-v5 with reciprocal changes in II, III, & avF. Taking the assessment into account and PMH, this is not a rate/rhythm issue, this is a dying heart issue. That said I still wouldn't treat the rate or…
2015-07-01 14:45:39
Vince DiGiulio
Conclusion to Snapshot Case: 85yo M – Chest Pain
Was pulling some links from this discussion for another article and your comment got me thinking a bit. Here's my take on aVR and LMCA lesions (which is pretty much just a re-phrasing of yours)... If you have an LMCA NSTEMI (meaning diffuse subendocardial ischemia with diffuse ST-depression) you're always going to get ST-elevation in…
2015-07-01 08:23:39
Laurie
59 Year Old Male: Unwell
Good thinking, Martin! Sometimes the best thing to do is nothing but treat the patient, not the monitor!!
2015-07-01 02:28:23
Nicole
59 Year Old Male: Unwell
Looks like acute MI and possible aspiration. I say intubate to protect airway and give meds to calm pt and regulate BP with fluids and pressors. Get pt to nearest hospital to stabalize and they can fly him/her to closest Cath lab. Time is life....or death. just do what you know! ABC's...or I guess its…
2015-07-01 02:23:22
Thomas
59 Year Old Male: Unwell
VT is dead regular (pun intended). This is A-fib with a rapid ventricular response and aberrancy. He feels crappy due to decreased cardiac output and he has SOB due to pulmonary congestion. CPAP is a good choice me thinks.
2015-07-01 01:45:22

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