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Bob Page Comes to Town

March 6, 2012

Bob Page came and delivered two days of excellent training for us at work last week.  He delivered a day and a half on 15 lead electrocardiology and half a day on waveform capnography.  Bob is the kind of instructor that inspires me to be a better paramedic and learn more about my craft every day.  I strongly encourage anyone who works in cardiology, emergency medicine, EMS, and related medical specialties to attend one of his classes. It really doesn’t mater if you are an RN, Paramedic, Respiratory Therapist or MD, you will almost assuredly learn something.  Bob will do classes just for you Doctors, so that you don’t have to associate with us lowly underlings. The main thing that he is passionate about is improving patient outcomes by changing the way that we provide care.

The first thing that Bob will teach you that cardiac monitoring should not be done in Lead II – For many of us this requires a real paradigm shift because it was all we were taught. He presents an overwhelming body of scientific evidence that Lead v1 (McL1) is a much better choice for continuous monitoring.

Here are some other pearls from his course:

Over oxygenation causes reperfusion injury. Reperfusion injury will kill more cardiac cells than the original MI.

Every second that the Cath Lab is delayed 500 heart cells die.

Annually, heart disease kills more women than all forms of cancer, combined.

Limb Leads are called limb leads because they go on the limbs. A 1975 study demonstrated that when the limbs go closer to the heart than the upper forearm / thighs it changes the angle and amplitude of the leads giving false positives.

12 Lead EKG’s and Waveform Capnography are theonly Type 1 Class A recommendations in the history of the American Heart association.

1 BPM increase in HR = 2% increase in o2 consumption.

So why bother to run a 15 Lead EKG instead of the standard 12 Lead that many have been doing for years?

50% of all MI patients have no STEMI on a 12 Lead EKG.

A 1993 Study proves increased sensitivity by running 3 extra leads – V4R, V8, & V9. Adding these three leads increases sensitivity of the EKG 23%. Simply put, there is no more reliable way to determine the presence of an isolated posterior wall or right ventricular MI. ST depression is not a reliable or specific indication of a posterior wall MI. Only 8% of posterior wall myocardial infarctions will have reciprocal changes. When the occlusion is in the circumflex artery – a 15 lead EKG increases sensitivity by 88%!!

1 in every 5 MI’s have right-sided involvement (20%). V4R is 88% sensitive and 96% specific for Right Ventricular Infarction.

5% of cases have both a Debachi 1 Aneurysm and a R side MI.  A history of hypertension and a STEMI of the Inferior Wall, Posterior Wall, and R Ventricle is an aneurysm. This type of  aneurism does not present with “ripping, tearing” pain or with limb inequality findings in the BP.  If there is no history of HTN, the pt is having a preload problem and must be treated accordingly.  There is not any other way to determine this condition in the field except a 15 Lead EKG.  As Bob says, it takes 20 seconds and costs 21 cents, what’s your excuse for not doing one?

I think this is all that I’m going to write for tonight, maybe I’ll do a write-up on the rest of the class later.


For now, go check out Bob’s website and sign up for a class:

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