Kate Martin CNE

Kate Martin CNEApril 2009

Kate Martin CNE

Chest pain that prompts a visit to the emergency department,

Post cardiac surgery Patients at risk for postoperative cardiac

complications after non-cardiac surgery.

Kate Martin CNE

Although chest pain is a real-time indicator of ischemia, up to 80% to 90% of ischemia is "silent" or "concealed”

Kate Martin CNE

12-lead (ECG), measurement of serum markers of injury, and cardiac catheterization, provide only a static "snapshot" of the dynamic process of ongoing ischemia.

Kate Martin CNE

Although the accuracy of continuous ST monitoring has improved with technology the diagnostic relevance of ST changes remains dependant on several factorsST segment changes may be an indication for a 12 lead EKG

Kate Martin CNE

On Admission Ensure skin is properly preppedEnsure leads are in proper positionRecord a baseline ST strip

Kate Martin CNE

Just like with a 12 lead EKG, lead placement should be accurate.The Phillips monitor can monitor ST segments on up to six leads on a telemetry unit and all 12 leads on a hardwire monitorChoose the leads which monitor the area of the heart most at risk

Kate Martin CNE

Kate Martin CNE

Kate Martin CNE

Kate Martin CNE

Kate Martin CNE

Kate Martin CNE

Kate Martin CNE

Kate Martin CNE

Kate Martin CNE

Kate Martin CNE

Kate Martin CNE

Leads I & V1-4 LAD LM

Kate Martin CNE

Leads avR, avL, & V5-6 Circumflex

Kate Martin CNE

Leads II, III, & avF RCA Circumflex

Kate Martin CNE

Leads I & V1-4 Mirror Image Posterior Artery

Kate Martin CNE

The ST segment begins at the point where the QRS ends (J-point). Diagnostic criteria of ST segment changes have been defined to be measured at 60 ms after the J-point (1.5 small squares/.06sec)

Kate Martin CNE

Kate Martin CNE

Digitalis ST depression Shortened QT interval

Amiodarone Lengthened QT interval

Kate Martin CNE

Pericarditis ST elevation

Hypothermia ST depression

Pulmonary Infarction Depressed ST segments and inverted T

waves in V 1 – 3

Kate Martin CNE

Bundle Branch Blocks ST segment shifts

Paced Rhythm ST segments non diagnostic

Kate Martin CNE

Is patient experiencing angina symptoms?

Follow ACS protocolIs patient hemodynamically unstable

Stabilize

Kate Martin CNE

Kate Martin CNE

Kate Martin CNE

A number of drugs are known to prolong the QT interval and include all of the antiarrhythmics

Kate Martin CNE

QT prolongation can indicate a risk of severe arrhythmias, torsades de pointes, and sudden cardiac death.

Kate Martin CNE

The QT has an inverse relationship to HR.QT = QTc at a HR of 60 bpm onlyHeart rate corrected QT interval is abbreviated as QTcNormal QTc is < 460 ms

Kate Martin CNE

Kate Martin CNE

Kate Martin CNE

“Cannot Analyze QT” INOP message:Flat T, Atrial Fib/FlutterProminent U WavesHighly variable QRS-T waveforms over 10 minutes duration

Clinical Verification:Widened QRS (Paced rhythm, bigeminal rhythm)High heart rates > 150 due to P waves being too close to T waves.

Kate Martin CNE

Leeper, B. Continuous ST-segment monitoring. AACN Clinical Issues 2003. 14(2): 145-154. American Association Of Critical Care Nurses St Segment Monitoring Practice AlertCritical Care Nurse. 2005; Clinical Usefulness of the EASI 12-Lead Continuous Electrocardiographic Monitoring System; Mary Jahrsdoerfer, RN, MHA.,Karen Giuliano, RN, PhD., Dean Stephens, RN, MS