New 80-lead EKG is easy to interpret
Recently, ED nurses at University of Virginia Health System in Charlottesville were given a two-hour in-service on the Prime ECG (manufactured by Columbia, MD-based Heartscape Technologies), reports William Brady, MD, a professor in the Department of Emergency Medicine at University of Virginia Health System in Charlottesville.
"It's not difficult in terms of actual performance," he says. "Once someone is comfortable with the technique, it takes about five or six minutes to interpret, compared to about three minutes for a 12-lead [EKG]. You use the same skills. You are just looking at 80 leads vs. 12."
To make interpreting the EKG easier, color maps flag blue areas as ST depression and red areas indicate ST elevation, so you can look for areas of abnormal color, adds Brady.
ED nurses already have used the 80-lead EKG on two patients, and both had their care and diagnosis changed as a result. "Both were having an MI that wasn't detected on the 12-lead," says Brady.
At Cleveland (OH) Clinic, all 65 ED nurses were inserviced on the use of the Prime ECG. Some volunteered for additional training and were given a pre- and post-test to demonstrate competency. Patricia M. Mahone, RN, assistant nurse manager of the ED, says, "These 'superusers' now troubleshoot on every shift and can run in and do the Prime ECG very quickly. It's very interesting to do a regular 12-lead [EKG] on someone and then bring the 80-lead in to see what the 12-lead isn't picking up."
At Delray Medical Center in Delray Beach, FL, all ED nurses were educated on the Prime ECG over six weeks, reports Margaret Neddo, RN, clinical manager of emergency services. ED nurses now do five to 10 Prime ECGs each month. "We had a patient with an [EKG] that was indeterminate of an MI. The ED physician ordered a Prime ECG, which revealed an evolving MI. The patient was subsequently taken to the cath lab and did very well," she reports.
At Cleveland Clinic, a patient with chest pain and a cardiac history had a 12-lead EKG that showed nothing, and the 80-lead EKG also showed nothing. He continued to have chest pain, and 14 minutes later had another Prime ECG that did show damage occurring. "He ended up going to the cath lab and had a great outcome," says Mahone. "In a case like that, you are looking at heart damage during the time it takes for the patient's condition to declare itself. Now we can see exactly what is going on, before it shows up on that 12-lead."
Sources/Resource
For more information on using the 80-lead electrocardiogram system in the ED, contact:
- William Brady, MD, Vice Chair, Department of Emergency Medicine, University of Virginia Health System, Charlottesville. Phone: (434) 924-8485. Fax: (434) 924-2877. E-mail: [email protected].
- Patricia M. Mahone, RN, Assistant Nurse Manager, Cleveland (OH) Clinic. Phone: (216) 444-0175. E-mail: [email protected].
- Margaret Neddo, RN, Clinical Manager, Emergency Services, Delray Medical Center, Delray Beach, FL. Phone: (561) 637-5344. Fax: (561) 495-3445. E-mail: [email protected].
The Prime ECG system uses 80 data collection points that provide a 360-degree view of the electrical activity of the heart. The disposable vest, which can be used for multiple serial readings on a patient, costs $200 per patient. The price of the cart is $45,000. For more information, contact:
- Paul Curley, Vice President of Marketing, Heartscape Technologies, Columbia, MD. Phone: (484) 593-0444. E-mail: [email protected]. Web: www.heartscape.com.
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