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ST Segment Monitoring in the ED

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Brian Ericson

on 16 March 2015

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Transcript of ST Segment Monitoring in the ED

Why Should We Be ST Segment Monitoring?
AHA Standard Guideline
Class I Recommendation
"Patients Who Present to the ED With Chest Pain or Anginal Equivalent Symptoms"
Silent Ischemia
Background Courtesy of Cross Duck
https://www.flickr.com/photos/18909153@N08/

Pearls Photo
https://www.flickr.com/photos/22901163@N03/


ST SEGMENT MONITORING
IN THE ED

We Are Equipped
To Do So
Setting up Phillips Monitor for EASI
EASI Placement
E
- (Brown)
E
xtreme bottom of sternum
A
- (Red) Left mid
a
xillary same transverse as E
S
- (Black)
S
ternal Manubrium

I
- (White) R
i
ght mid axillary, same line as E
The
Green
lead is a
Ground

The old saying still applies but angled - "Smoke over fire and clouds over earth" Then just know that Brown is the bottom of the sternum
We need to monitor this effectively to be better at detecting silent ischemia
HOW?
ST Segment monitoring with Philips
EASI lead placement
Filling the Knowledge Gap
ST Segment Monitoring on Philips MP50
EXPECTED OUTCOMES
PEARLS
Summary
References
Leads to Monitor
ACS Rule Out - Minimum of V3 and Lead III
12 Lead contiguous
Thresholds
Priorities of Analysis
Assess ST Elevation
Assess for for T wave inversion (NSTEMI or unstable angina)
Assess for ST depression
Class III
LBB
Ventricularly Paced
Arrhythmias that obscure ST
Agitation
Body Position
Careful Prep
Lead Placement
Tailor Alarms
Understand our goals
Analyze
Class I AHA Recommendation
Silent Ischemia
EASI Lead Placement
ST Segment changes
Analysis
Save a life!
Akkerhuis, K.M. et al. Recurrent ischaemia during continuous multilead ST-segment monitoring identifies patients with acute coronary syndromes at hig risk of adverse cardiac events; meta-analysis of three studies involving 995 patients. European heart Journal, 22(21), 1997-2006.

Drew, B. J., Califf, R. M., Funk, M., Kaufman, E. S., Krucoff, M. W., Laks, M. M., ... & Van Hare, G. F. (2004). Practice Standards for Electrocardiographic Monitoring in Hospital Settings An American Heart Association Scientific Statement From the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: Endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses. Circulation, 110(17), 2721-2746.

Hamm, C. W., Bassand, J. P., Agewall, S., Bax, J., Boersma, E., Bueno, H., ... & Hambrecht, R. (2011). ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). European heart journal, 32(23), 2999-3054.

Kligfield, P., Gettes, L. S., Bailey, J. J., Childers, R., Deal, B. J., Hancock, E. W., ... & Wagner, G. S. (2007). Recommendations for the standardization and interpretation of the electrocardiogram: part I: the electrocardiogram and its technology a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society endorsed by the International Society for Computerized Electrocardiology. Journal of the American College of Cardiology, 49(10), 1109-1127.

Patwari, Rahul. EKG: ST Segments.

Redley, B. (2005). EASI ECG Monitoring vs Traditional 12 – Lead ECG. A Review of the Literature. Center for Clinical Nursing Research Deakin University.

Sandau, K. E., & Smith, M. (2009). Continuous ST-segment monitoring: protocol for practice. Critical care nurse, 29(4), 39-49.

Sangkachand, P., Sarosario, B., & Funk, M. (2011). Continuous ST-segment monitoring: nurses’ attitudes, practices, and quality of patient care. American Journal of Critical Care, 20(3), 226-238.
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