I'm new to cardiac nursing and I'm getting confused about which leads to view on our monitor. We use 5 leads. When I was starting my shift, the night nurse had a patient who was in a BBB on aVR. She said it was the best lead to watch someone in a BBB, but she couldn't explain "why". I don't understand why some of these seasoned nurses choose the leads that they choose and why. Like, if someone is in junctional, is there a certain lead that I should pick?
Also, I have study guides, but I can't differentiate a LBBB from a RBBB.
Finally, some of the nurses aren't concerned about some of the rhythms. I know which rhythms per ACLS are critical and warrant a call to the MD. But what about the rhythms that aren't critical, when would I call the doctor to let him know. The other day, got a new admit from ED and in report we were told he was in SR. But when we got him, he was in a 1st degree . My preceptor didn't call the MD to tell him and told me that if I called the MD about that, it "wouldn't be pretty". Well, which rhythms DO warrant a call aside from ACLS rythmns and a new onset of Afib???
Jun 1, '13
by Esme12, ASN, BSN, RN Senior Moderator
Quote from raindrop
A big, fat THANK You to you both, TopsDrop & Turnforthenurse!!! Everything you wrote makes sense to me.
Now if I may pick your brains on a few other things:
And when talking about 5 lead monitoring. I know the Brown Lead is the V lead. But what are the White, Red, green, etc?
And there have been times where patients have had a run of Vtach, but are fine. And the nurses do nothing since they are asymptomatic. But I always thought the MD should be notified! Just because they are fine this time, doesn't mean that the next run will be fine. My preceptor said she only notified the MD if it happens alot. Uggh. Well, I tend to err on the side of caution. If a patient had a 4 beat run of Vtach on you, but were asymptomatic. What would you do???
Are you on orientation? Are you a new grad? Have you had any EKG courses yet?
EKG leads.....White is right (shoulder/side), Black is the opposite of white so that is left(shoulder/side).......green is ground on the right lower abdomen and brown is ground so left lower abdomen. http://www.aacn.org/WD/Practice/Docs...ocket_card.pdf
Using a 5 lead system.....many cardiologists like MCL1 or V1 to monitor heart patients.....it is a diagnostic lead for VT/SVT and it is the lead where you can see the development of a BBB R or L which when a new finding is an indication of an extension of a MI of a new MI has occurred. The development of a New RBBB is an ominous sign and carries a less positive prognosis.
An Introduction to MCL1
The best leads to monitor BBB is V1 MCL1.....I haven't heard of using AVR....that is a diagnostic lead but not significant to standard monitoring.
When to give meds and why is a multifunctional problem....it depends on the patient and what the ejection fraction is......some patients need the meds given outside the "normal parameters" as their cardiac function is so poor and so fragile that they need the preload, after load reduction, vasodilitation properties to stay out of failure. It is best to always ask the MD and get parameters AND know what your policy and procedures are for your facility for these meds....for standards of care.
4 beats of VT is 4 beats of VT...I would rather get yelled at for calling instead of sued because I didn't.....however if this is a common arrhythmia for this patient and they have a history of this AND the MD notes it in his progress notes...no I wouldn't call.
1 degree AV block I probably would not call especially if they are on meds and have a history of this....however if this patient has been in for a few days and develops a 1 degree.....I would notify the MD...if on nights I would call in the morning before I went home.
Last edit by Esme12 on Jun 1, '13