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The case of a misleading EKG trace
24 GiuThis post was inspired by Carmine Della Vella and I want to thank him for the great contribution.
Is a hot afternoon of a summer day. You are on duty in an EMS local station and your Physiocontrol LP 12 looks like to have some trouble. You decide to make a try on an healthy volunteer. So pick up the first local guy passing by from the station that happens to be a 20 yrs old young male with no medical history. Set you LP 12 on, attach the 12 leads and print the EKG trace. BOOM!!!
It doesn’t look any good!!!!!
So you wonder how to find an explanation of this terrible trace: STEMI, Brugada like pattern, Spoddik sign, Wellens ????
Doesn’t sound good at all, it look likes we are missing something.
And when you just t bring to the unaware guy the terrible news here comes the light!!
The LP12 was in monitoring mode and not in diagnostic 12 lead EKG mode!!!
What that means ?
When the LP 12 is on monitoring mode the low frequency filter (also called high-pass filter because signals above the threshold are allowed to pass) is set at either 0,5 Hz or or 1 Hz and the high-frequency filter (also called the low-pass filter because signals below the threshold are allowed to pass) is set at 40 Hz. This limits artifacts for routine cardiac rhythm monitoring. In diagnostic mode, the high-pass filter is set at 0.05 Hz, which allows accurate ST segments to be recorded. The low-pass filter is set to 40, 100, or 150 Hz. As a consequence, the monitor mode ECG display is more filtered than diagnostic mode, because its passband is narrower.
Remember that the ST segment is a very low frequency part of the EKG tracing (the slope of the line is very flat) and so in monitor mode with the lower filter set to 0.5 or 1 Hz, it’s not low enough to accurately obtain the tracing. Diagnostic mode with a lower filter of 0.05 will produce an accurate tracing.
This is true even for LP 15 as reported on Operating instructions
Anyway the 12 lead EKG was repeated in diagnostic mode and resulted totally normal.
References
Operating instructions Lifepak® 15 monitor/defibrillator – Physio Control. Section 4.
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