5 - Lead EKG, I hate it

[Surfer]

I hate the 5 lead ECG. Except in the most extreme of patients, its overkill and we only use it because its there. If you use a 3 lead you're seen as "lazy" even though nobody pays attention to the 5 lead anyway. In fact, whenever you see ECG weirdness you simply write it off as "must be lead placement." Except in extreme circumstances.

The 5 lead ECG needs to go in the garbage. The 3 lead is much better.

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[Surfer]

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[2win]

I hate the 5 lead ECG. Except in the most extreme of patients, its overkill and we only use it because its there. If you use a 3 lead you're seen as "lazy" even though nobody pays attention to the 5 lead anyway. In fact, whenever you see ECG weirdness you simply write it off as "must be lead placement." Except in extreme circumstances.

The 5 lead ECG needs to go in the garbage. The 3 lead is much better.

Last time I used a 5 lead intraop was in the residency....

 

[thegasman]

you guys are slack. 3 lead ecg is not very good for picking up intraoperative ischemia. We take care of old sick patients all the time. How much extra work does it take to put two extra stickers on the patient? For the young and healthy it is not necessary, but these are sometimes few and far between.

 

[Pilot Doc]

one of the many reasons I like peds 🙂

 

[pgg]

JFC. I really don't know what to say to this.

Really, I tried writing something to humorously snarkily express my incredulity that there exist anesthesiologists out there who think V5 is universally useless, but I coudn't.

 

[Planktonmd]

I am all in favor of making things as simple as possible, but in my opinion a 5 lead monitor with leads II and V5 on the screen is a good thing to have in some patients.
This is true if you are the one doing the anesthetic yourself but if you are supervising CRNA's who would not recognize ischemia if it hit them in the face, then it doesn't matter, you can even do anesthesia with no EKG monitroring at all.

 

[2win]

I am all in favor of making things as simple as possible, but in my opinion a 5 lead monitor with leads II and V5 on the screen is a good thing to have in some patients.
This is true if you are the one doing the anesthetic yourself but if you are supervising CRNA's who would not recognize ischemia if it hit them in the face, then it doesn't matter, you can even do anesthesia with no EKG monitroring at all.

Although I understand the logic - look after this article:
Best leads in the standard electrocardiogram for the emergency detection of acute coronary syndrome
Michael Green, MSc,a,4 Mattias Ohlsson, PhD,a Jakob Lundager Forberg, MD,b Jonas Bjfrk, PhD,d Lars Edenbrandt, MD, PhD,c Ulf Ekelund, MD, PhDb

 

[Planktonmd]

Although I understand the logic - look after this article:
Best leads in the standard electrocardiogram for the emergency detection of acute coronary syndrome
Michael Green, MSc,a,4 Mattias Ohlsson, PhD,a Jakob Lundager Forberg, MD,b Jonas Bjfrk, PhD,d Lars Edenbrandt, MD, PhD,c Ulf Ekelund, MD, PhDb

Nice,
But how do you apply the results of this study to figure out which 2 leads to monitor intraoperatively?

 

[2win]

Nice,
But how do you apply the results of this study to figure out which 2 leads to monitor intraoperatively?

AVL and III.

 

[Planktonmd]

AVL and III.

That's not what the study you qouted said!
It said that the best single lead was AVL and the best combination of 3 leads was III + AVL + V2
How did you come up with the conclusion that the best TWO leads combination is AVL and III???
Why not AVL and V2?
And it seems that this study is addressing 12 lead EKG's obtained in the ER not continous monitoring as judged by live observers.

 

[2win]

That's not what the study you qouted said!
It said that the best single lead was AVL and the best combination of 3 leads was III + AVL + V2
How did you come up with the conclusion that the best TWO leads combination is AVL and III???
Why not AVL and V2?
And it seems that this study is addressing 12 lead EKG's obtained in the ER not continous monitoring as judged by live observers.

You are right that the study showed the best combination III+AVL+V2.
If you look though to this study too:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC483087/?page=5

you'll see that "In summary the 3 lead ecg has been shown to have an enhanced index of merit for the prediction of the presence or the absence of coronary artery disease and has an equal ability to indicate the site of myocardial ischemia compared with the 12 lead ecg."
Comparison of 12-lead and computer-analysed 3 orthogonal lead electocardiogram in coronary artery disease.
R G Murray, A R Lorimer, F G Dunn, P W Macfarlane, I Hutton, and T D Lawrie

I am far away to be a specialist in ECG so I can be wrong....

 

[Bertelman]

You are right that the study showed the best combination III+AVL+V2.
If you look though to this study too:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC483087/?page=5

you'll see that "In summary the 3 lead ecg has been shown to have an enhanced index of merit for the prediction of the presence or the absence of coronary artery disease and has an equal ability to indicate the site of myocardial ischemia compared with the 12 lead ecg."
Comparison of 12-lead and computer-analysed 3 orthogonal lead electocardiogram in coronary artery disease.
R G Murray, A R Lorimer, F G Dunn, P W Macfarlane, I Hutton, and T D Lawrie

In the time you have spent prowling the internet for your justification, you could have slapped two more leads on each of your patients in December.

- Just sayin'

 

[2win]

In the time you have spent prowling the internet for your justification, you could have slapped two more leads on each of your patients in December.

- Just sayin'

Your reply proves that the admission process in residency is still an easy one.LOL

 

[Bertelman]

Your reply proves that the admission process in residency is still an easy one.LOL

...while yours demonstrates I might actually know more than some of my attendings, which I occasionally suspect.

 

[2win]

...while yours demonstrates I might actually know more than some of my attendings, which I occasionally suspect.

“Provided a man is not mad, he can be cured of every folly but vanity”
JJR

 

[pgg]

“Provided a man is not mad, he can be cured of every folly but vanity”
JJR

Pot, kettle, black, etc. 🙄

 

[2win]

Pot, kettle, black, etc. 🙄

Hey pgg - besides your thoughtful remark - do you have something intelligent to say about the ekg - 3 versus 5? Maybe you'll help me to change my practice. The question was a simple one - why 5 versus 3? Give me your Cali answer.

 

[pgg]

Hey pgg - besides your thoughtful remark - do you have something intelligent to say about the ekg - 3 versus 5? Maybe you'll help me to change my practice. The question was a simple one - why 5 versus 3? Give me your Cali answer.

The answer is simple: putting on two extra leads is a 4-second task that has no cost, zero risk, and is superior for detecting ischemia.

Why on earth would you NOT use 5 in patients at risk for ischemia?

To take your "I never use 5 leads" stance a step further, why use an ECG at all? You can get rate/rhythm information from the pulse ox. Save yourself 4 more seconds and skip it completely.

 

[MRW]

Pulse ox is for wimps. A stethoscope is all you need.

 

[2win]

The answer is simple: putting on two extra leads is a 4-second task that has no cost, zero risk, and is superior for detecting ischemia.

Why on earth would you NOT use 5 in patients at risk for ischemia?

To take your "I never use 5 leads" stance a step further, why use an ECG at all? You can get rate/rhythm information from the pulse ox. Save yourself 4 more seconds and skip it completely.

The point in the study pointed earlier was that the 3 leads are the same with 5 for detecting ischemia.
The pulse ox and rate is an entirely another discussion - interesting though.
And I could ask you why 5 and not 12 leads? 12 is superior to 5...
I could say also that this is a 14 seconds extra task...😉