Data suggest that leads III and V3 should be used to perform ST segment monitoring in patients with acute coronary artery syndrome. Lead II is useful for general cardiac monitoring, but it is not especially helpful for ST segment monitoring.
Leads V6 and I are helpful together for distinguishing ventricular aberration but not for ST segment monitoring.
The 12-lead ECG represents a narrow complex tachycardia. Immediate interventions for this stable tachycardia with an acceptable blood pressure include having the patient perform vagal maeuvers to slow conduction from the SA node to the AV node.
If this is ineffective in slowing or terminating the tachycardia, the next intervention would be to administer adenosine. Adenosine causes transient block in AV node conduction, which may cause asystole is contraindicated.
Diltiazem is indicated for rate control in atrial fibrillation with a rapid ventricular rate. Synchronized cardio version is indicated for unstable supraventricular tachycardias.
Right branch bundle block is demonstrated by an rSR' pattern in leads V1 or V2 (the right chest leads), a slurred S wave in V5 and V6 and a QRS duration of greater than 0.12 seconds. LBBB would be demonstrated by a deep S wave in the right chest leads and a QRS greater than 0.12 seconds in leads V5 and V6. The heart rate is 100 BPM in this ECG so it does not qualify as tachycardia. There is ST segment depression in the anterior leads (V2-V5), which does not signify acute MI. Acute anterior MI would be demonstrated by ST segment elevation or Q waves in the anterior leads.
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The Scope of the Problem
Electrocardiogram (ECG) monitoring is no longer isolated to critical care units. In today's hospitals, ECG monitoring technology is utilized throughout the healthcare facility on progressive care units, medical telemetry units, pediatric stepdown units, long-term acute care units and high risk obstetric units. It is a vital component of the care provided by acute and critical care nurses and provides us with an enormous amount of clinical information about acute and critically ill patients.
As a result of technological advances in bedside monitoring, the need for human oversight to interpret ECG monitoring data is more important than ever before. From analyzing alarms to determine their validity, to ST segment monitoring to detect early myocardial ischemia, developing an expertise in ECG interpretation is a key contribution of acute and critical care nurses today.
Test Your Knowledge
Source: AACN Certification and Core Review for High Acuity and Critical Care, 6th Edition
Reference
Drew BJ, Califf RM, Funk M, et al. 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. 2004; 110: 2721-2746.
