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Paramedic Identification of Electrocardiograph J-Point and ST-Segments

Published online by Cambridge University Press:  28 June 2012

Brett Williams ,
Mal Boyle  and
Bill Lord
Brett Williams*
Affiliation:
Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
Mal Boyle
Affiliation:
Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
Bill Lord
Affiliation:
Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
*
Monash UniversityDepartment of Community Emergency Health and Paramedic PracticeBuilding HMcMahons RoadFrankston 3199Victoria, Australia
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Abstract

Introduction:

Correct identification of the J-Point and ST-segment on an electrocardiograph (ECG) is an important clinical skill for paramedics working in acute healthcare settings. The skill of ECG analysis and interpretation is known to be challenging to learn and often is a difficult concept to teach.

Objectives:

The objective of the study was to determine if undergraduate paramedic students could accurately identify ECG ST-segment elevation and J-Point location.

Methods:

A convenience sample of undergraduate paramedic students (n = 148) was provided with four enlarged ECGs (ECG1–4) that illustrated different levels, patterns, and characteristics of ST-segment elevation. Participants were asked to identify whether ST-elevation was present, and if so, height in millimeters (mm) and the correct location of the J-Point.

Results:

There were significant variations in students'accuracy with both J-Point and ST-segment determination. Eleven (10%) students correctly identified the ST-segment being present in all ECGs. Also, ECG 2 reflected 6 mm of ST-elevation; however, only one student correctly identified this. Overall the students were 0.55 mm (95% CI = 0.29–0.81 mm, range = -6.5–5.8 mm) from the J-point on the horizontal and -0.18 mm (95% CI = -0.31–0.04 mm, range = -2.8–2.3 mm) on the vertical axis.

Conclusions:

Undergraduate paramedic students recognize ST-segment elevation. However, inaccuracies occurred with measurements of ST-segment and precise location of J-Points. Errors in ECG analysis may reflect weaknesses in teaching this skill. Consideration should be given to the design of an educational program that can reliably improve performance of this skill.

Keywords

electrocardiographyemergency medical servicesemergency medical techniciansJ-Pointprehospital careST-segment
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 23 , Issue 6 , December 2008 , pp. 526 - 529
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2008

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References

1.Brady, WJ Jr, DeBehnke, DJ, Wickman, LL, et al. : Treatment of out-of-hospital supraventricular tachycardia: Adenosine vs verapamil. Acad Emerg Med 1996;3(6):574–585.Google ScholarPubMed
2.Furlong, R, Gerhardt, RT, Farber, P, et al. : Intravenous adenosine as first-line prehospital management of narrow-complex tachycardias by EMS personnel without direct physician control. Am J Emerg Med 1995;13(4):383–388.Google Scholar
3.Gausche, M, Persse, DE, Sugarman, T, et al. : Adenosine for the prehospital treatment of paroxysmal supraventricular tachycardia. Ann Emerg Med 1994;24(2):183–189.CrossRefGoogle ScholarPubMed
4.Goebel, PJ, Daya, MR, Gunnels, MD: Accuracy of arrhythmia recognition in paramedic treatment of paroxysmal supraventricular tachycardia: A ten-year review. Prehosp Emerg Care 2004;8(2):166–170.Google ScholarPubMed
5.Hill, R, Heller, M, Rosenau, A, et al. : Paramedic interpretation of prehospital lead-ii st-segment. Prehospital Disast Med 1997;12(2):141–144.CrossRefGoogle Scholar
6.Lozano, M Jr., McIntosh, BA, Giordano, LM: Effect of adenosine on the management of supraventricular tachycardia by urban paramedics. Ann Emerg Med 1995;26(6):691–696.CrossRefGoogle ScholarPubMed
7.Madsen, CD, Pointer, JE, Lynch, TG: A comparison of adenosine and vera-pamil for the treatment of supraventricular tachycardia in the prehospital setting. Ann Emerg Med 1995;25(5):649–655.Google Scholar
8.McCabe, JL, Adhar, GC, Menegazzi, JJ, et al. : Intravenous adenosine in the prehospital treatment of paroxysmal supraventricular tachycardia. Ann Emerg Med 1992;21(4):358–361.CrossRefGoogle ScholarPubMed
9.Morrison, LJ, Allan, R, Vermeulen, M, et al. : Conversion rates for prehospital paroxysmal supraventricular tachycardia (psvt) with the addition of adeno-sine: A before-and-after trial. Prehosp Emerg Care 2001;5(4):353–359.CrossRefGoogle Scholar
10.Wittwer, LK, Muhr, MD: Adenosine for the treatment of PSVT in the pre-hospital arena: Efficacy of an initial 6 mg dosing regimen. Prehospital Disast Med 1997;12(3):237–239.CrossRefGoogle Scholar
11.Sejersten, M, Young, D, Clemmensen, P, et al. : Comparison of the ability of paramedics with that of cardiologists in diagnosing ST-segment elevation acute myocardial infarction in patients with acute chest pain. Am J Cardiol 2002;90(9):995–998.CrossRefGoogle ScholarPubMed
12. Part 5: Acute coronary syndromes. Resuscitation 2005;67(2-3):249–269.CrossRefGoogle Scholar