ST alarming on tele mgr but no acute MI

[Jsy0013]

I am fairly new to the Telemetry floor...I cared for a pt who is in a-fib, had a cardioversion and came back to the floor in sinus rhythm during the am shift. When I came on for the evening shift, her STs were alarming in all leads. I ordered a 12 lead which showed no acute changes. The cardiologist said I could shut off her ST alarms in the tele mtr...here is my question, why were STs alarming if there was no acute change on the 12 lead. Thx in advance....FYI this floor stresses me out!

[CCL RN, RN]

Because alarms should never replace humans.

You looked at the 12 lead, were there changes? Was the pt having CP, or hemodynamic instability?

[casi, ASN, RN]

Because the alarms like to alarm for stupid not real reasons sometimes. They also will occassionally not alarm for something like vtach

[nursej22, MSN, RN]

Right bundle branch block, left ventricular hypertrophy? Pericarditis? Electrolyte abnormalities?

But...in the end, treat the patient, not the monitor.

[shadowflightnurse]

First of all, I would NOT turn off the alarms on the monitor. This is a big NO NO (pt safety, JCAHO, etc).

As the other posters mentioned, there are many reasons the alarms could be going off. Sounds like you did the right thing (assessed pt, EKG, callled MD, etc). Since you now know the alarms are false, I would look at the settings on the monitor. On many of the machines, you can change the threshold of what will set the alarm off. You can then increase the threshold above what the patient's ST's are showing. Just remember to change the setting back to the default after that patient is discharged.

[A&OxNone, MSN, RN]

Sometimes, those things are great, Sometimes, they are dumb. A few weeks ago, my pt is in OBVIOUS Vtach, and it wasn't alarming. And when we did a 12 lead, it called it A flutter. Not really sure WHAT it was thinking...

[turnforthenurse, MSN, NP]

Movement?

I know I had a patient who would move around and the tele monitor would show vtach...but no signs of hemodynamic compromise or anything. Pt felt fine.

It all boils down to assessing your patient.

I would never silence the alarms, though. What if it really IS ST-segment elevation or vtach or something?

[suanna]

That's what we get the big bucks for. An alarm is only to call your attention to some parameter that the monitor felt was changed. As you get more experience you will learn a lot of tricks to help silence those false alarms without compromising patient safety- lead changes, lead position, tele gain setting, and in some cases you can turn off some alarms if you have done your assessment and determined that there is no validity to the alarm and there is no way to effectively monitor whatever is alarming given the level of complexity of the monitor in use. If you do turn off an alarm- what you are saying is the machine isn't smart enough to monitor for this so you are taking the responsibility for that monitoring. It involves much closer observation on your part.