Beach Balls
“The minute you get away from fundamentals –whether its proper technique, work ethic or mental preparation –the bottom can fall out of your game, your schoolwork, your job, whatever you’re doing.”-Michael Jordan
When I was studying geology at UB, one of my classes was Geophysics. No, it isn’t nearly as difficult as you might first think, but it was challenging at times. In geophysics we learned about these things called“beach balls.” In layman’s terms, a beach ball is a diagram which is created after an earthquake event. It is a visual representation of the direction of the forces involved with the earthquake and what happened to the bedrock surrounding those areas.
<--Beach balls looked like this on a map. They were frequently drawn by hand, and measuring the angles manually was a real pain in the you-know-what. I recall asking my professor why we needed to produce these beach balls when for years there had been sophisticated computers that gave us all of the data we needed for any earthquake that happened. The response that I got was “this is the way you learn the fundamentals –the computer won’t tell you what you’re really looking at. It will only give you numbers.”
At the time, I immediately thought about EMS and some of the developing technology we were seeing. I thought about my instructor Tom Luca telling us to “treat the patient, not the monitor.” Good advice, but sometimes lost on the new provider.A few months back I came across a 12-lead ECG which really struck me because the computer completely misinterpreted the reading. I mean REALLY misinterpreted. It was a third degree block with a ventricular rate of MAYBE 20. The computer called it “normal sinus rhythm. I don’t believe that any good medic would not have recognized it for what it was, but who knows?
Years ago I saw a paramedic who was preparing to cardiovert a patient in atrial flutter. The base rate was 140-ish, but the monitor was picking up frequent artifact as complexes and had the rate listed at 200. I ran a strip for the medic and handed it to him, and when he counted out the beats the old fashioned way, sure enough, his dependence on technology was cured. (And the patient didn’t receive unnecessary electrical shocks!)
We do a lot of great things with the technology we’ve got, but there is something to be said for going back to the fundamentals –those things that many old providers learned and either passed on or forgot about. The base knowledge we have allows us to build upon a strong foundation as we grow in our field.
For the sake of fundamentals review, how do you determine the heart rate without the pesky monitor lying to you?
First, find a QRS complex which falls on a darker line. Then see where the next complex falls. If it is one large box away, the rate is approximately 300 (very bad). Two big boxes away is approximately 150, and so on as pictured to the left.You do however need to print out a strip on paper to use this method.
The other way to determine rate is to count the number of QRS complexes in a six-second strip and then multiply by 10.Here is a six-second strip. Count the number of complexes there. (20), multiply by 10 and your rate is 200 (still bad)And if you use the first method, you’ll see that your second complex falls about a box and a half away from the first which puts the rate between 300 and 150. BINGO!
Some questions to consider:
1.What are some of the fundamentals in patient care that have changed or have been replaced by technology since you started?
2.Do you think it is worthwhile to study and review fundamentals, even if they are not immediately useful during a patient encounter?
3.Have you ever found yourself following a patient cart protocol but not really being able to explain it?
4.Have you ever done a procedure or given a medication simply because it is in protocol, not thinking about the actual way that it affects the body?
New medics / old medics, medic students: What are the rates below?
When I was studying geology at UB, one of my classes was Geophysics. No, it isn’t nearly as difficult as you might first think, but it was challenging at times. In geophysics we learned about these things called“beach balls.” In layman’s terms, a beach ball is a diagram which is created after an earthquake event. It is a visual representation of the direction of the forces involved with the earthquake and what happened to the bedrock surrounding those areas.
At the time, I immediately thought about EMS and some of the developing technology we were seeing. I thought about my instructor Tom Luca telling us to “treat the patient, not the monitor.” Good advice, but sometimes lost on the new provider.A few months back I came across a 12-lead ECG which really struck me because the computer completely misinterpreted the reading. I mean REALLY misinterpreted. It was a third degree block with a ventricular rate of MAYBE 20. The computer called it “normal sinus rhythm. I don’t believe that any good medic would not have recognized it for what it was, but who knows?
Years ago I saw a paramedic who was preparing to cardiovert a patient in atrial flutter. The base rate was 140-ish, but the monitor was picking up frequent artifact as complexes and had the rate listed at 200. I ran a strip for the medic and handed it to him, and when he counted out the beats the old fashioned way, sure enough, his dependence on technology was cured. (And the patient didn’t receive unnecessary electrical shocks!)
We do a lot of great things with the technology we’ve got, but there is something to be said for going back to the fundamentals –those things that many old providers learned and either passed on or forgot about. The base knowledge we have allows us to build upon a strong foundation as we grow in our field.
For the sake of fundamentals review, how do you determine the heart rate without the pesky monitor lying to you?
First, find a QRS complex which falls on a darker line. Then see where the next complex falls. If it is one large box away, the rate is approximately 300 (very bad). Two big boxes away is approximately 150, and so on as pictured to the left.You do however need to print out a strip on paper to use this method.
The other way to determine rate is to count the number of QRS complexes in a six-second strip and then multiply by 10.Here is a six-second strip. Count the number of complexes there. (20), multiply by 10 and your rate is 200 (still bad)And if you use the first method, you’ll see that your second complex falls about a box and a half away from the first which puts the rate between 300 and 150. BINGO!Some questions to consider:
1.What are some of the fundamentals in patient care that have changed or have been replaced by technology since you started?
2.Do you think it is worthwhile to study and review fundamentals, even if they are not immediately useful during a patient encounter?
3.Have you ever found yourself following a patient cart protocol but not really being able to explain it?
4.Have you ever done a procedure or given a medication simply because it is in protocol, not thinking about the actual way that it affects the body?
New medics / old medics, medic students: What are the rates below?
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