Gasbag Anaesthesia Forums

Please login or register.

Login with username, password and session length
Advanced search  

Poll

Question: When do you apply ECG monitoring to your GA patient?

  • Always
    - 17 (51.5%)
    Almost always
    - 8 (24.2%)
    Only if indicated
    - 7 (21.2%)
    Never
    - 1 (3%)

Total Members Voted: 33

Author Topic: ECGs for everybody?  (Read 5182 times)

0 Members and 1 Guest are viewing this topic.

Russell Coupland

  • Newbie
  • *
  • Posts: 16
    • View Profile
ECGs for everybody?
« on: January 06, 2005, 12:57:59 PM »
I do not use ECGs monitoring routinely during anesthesia. In fact, I would estimate less than 50% of my patients warrent ECG monitoring. If the patient is young (less than 50) with no cardiac history and no history of arrhythmia, then I do not use ECG monitoring. I have it available if needed, but rarely have I had to apply it at a later stage. My pulse oximeter gives me all the info I need regarding heart rate and rhythm.

I find that I sometimes have to argue the point strongly with my assistant or resident. Yet, when I ask them to justify ECG use in every patient, they are at a loss.

I am interested to hear how many others do NOT use ECG routinely.
« Last Edit: January 06, 2005, 01:15:06 PM by Robert Lang »
Logged

George Miklos

  • Newbie
  • *
  • Posts: 15
    • View Profile
Re: ECGs for everybody?
« Reply #1 on: January 12, 2005, 06:02:25 AM »
ECG is such a non-invasive monitor that its risk-benefit ration is hugely in favor of its use. Easy, quick, risk-free and occassionally very useful. Why would you NOT use it?
Logged

Russell Coupland

  • Newbie
  • *
  • Posts: 16
    • View Profile
Re: ECGs for everybody?
« Reply #2 on: January 12, 2005, 03:17:41 PM »
Why would you NOT use it?

Because they are an anachronistic waste of time in most patients.
 :P
Logged

Bucky

  • Newbie
  • *
  • Posts: 14
    • View Profile
Re: ECGs for everybody?
« Reply #3 on: January 16, 2005, 09:08:24 AM »

I'm with Dr Coupland - ECGs tell me little of value 99.999% of the time.

Having said that, I do use them for all GAs, but that is entirely for medicolegal reasons.

I'll admit to sometimes forgetting to put them on during spinals and epidurals, particularly short cases such as D&C.

One thing that I'm quite sure is a waste and that is monitoring the ECG is the PACU in most cases.  To that end, I don't require ECG monitoring in PACU.

Pulse Ox rules and tells me far more.
Logged

Michael de Sousa

  • Newbie
  • *
  • Posts: 12
  • deep south
    • View Profile
Re: ECGs for everybody?
« Reply #4 on: January 20, 2005, 07:14:35 AM »
ECG is harmless, non-invasive, easy and occassionally is the first sign of ischemia or arrhythmia. Riskbenefit ration strongly in favor of using it always!
Logged

jetproppilot

  • Newbie
  • *
  • Posts: 14
    • View Profile
Re: ECGs for everybody?
« Reply #5 on: January 21, 2005, 12:16:41 PM »
Yes, I see your point. I use it on all patients but have had equipment failure more than once (cable problem or whatever) and didnt worry about it. I could do knee scopes on young patients, C sections, etc all day long without an ECG and not bat an eye but as one of the posters indicated lawyers are sharks!!! haha
Logged

Matthew Parsons

  • Newbie
  • *
  • Posts: 12
    • View Profile
Re: ECGs for everybody?
« Reply #6 on: January 26, 2005, 06:00:48 AM »
My college guidelines state that ECG needs to be available for every patinet but not necessarily applied to every patient (unlike pulse oximetry, BP, capnography, gas analysis - all of which must be applied for every GA). Having said that, I must admit I see little harm in using it on almsot everybody.
Logged

gasman

  • Administrator
  • Newbie
  • *****
  • Posts: 24
    • View Profile
    • Email
Re: ECGs for everybody?
« Reply #7 on: January 26, 2005, 06:04:01 AM »
Having said that, I must admit I see little harm in using it on almsot everybody.

A few years ago in my hospital, there was a adult who had a GA for an MRI scan (the GA because she was severely claustrophobic). All went well until the staff re-entered the MRI room at the end and noticed a nasty burning smell. The MRI had induced a current within the ECG dots and had caused burns on all three locations. Required skin grafts to repair. And these were MRI-approved ECG dots!
« Last Edit: February 10, 2005, 03:12:21 PM by Robert Lang »
Logged

ether_screen

  • Newbie
  • *
  • Posts: 1
    • View Profile
Re: ECGs for everybody?
« Reply #8 on: January 26, 2005, 12:07:53 PM »
ECG monitoring is a standard of care set forth by both the ASA and AANA.  Itsí application requires all of 15 seconds, costs almost nothing, and has an unquestionable risk/benefit ratio.  Iím surprised some providers consider omission of this technology an option.
Logged

Russell Coupland

  • Newbie
  • *
  • Posts: 16
    • View Profile
Re: ECGs for everybody?
« Reply #9 on: January 26, 2005, 03:25:17 PM »
and has an unquestionable risk/benefit ratio.† Iím surprised some providers consider omission of this technology an option.

In my opinion, it has no benefit in young ASA class I or II patients. It gets in the way, wastes time, gives artefacts (especially when diathermy is used) that cause spurious heart rate recordings for no benefit. I'm surprised it is still a part of the ASA Guidelines, and as others have mentioned, it is optional in other countries.
Logged

hdesousa

  • Newbie
  • *
  • Posts: 2
    • View Profile
    • Email
Re: ECGs for everybody?
« Reply #10 on: March 26, 2005, 11:30:13 AM »
ECG monitoring is a standard of care set forth by both the ASA and AANA.  Itsí application requires all of 15 seconds, costs almost nothing, and has an unquestionable risk/benefit ratio.  Iím surprised some providers consider omission of this technology an option.

Routine ECG monitoring of a healthy heart provides no useful information and can be distracting to the point of causing death.
True example, from the days before routine EtCO2  and SpO2 monitoring and when hanging ventilator bellows were common place:
A poorly supervised very 'young' trainee did not recognize a circuit disconnect during an abdominal surgical procdure on a healthy 30 some year old. As he had been taught, the trainee treated bradycardia with atropine, all the time paying more attebtion to the ECG than to anything else.  The patient did not survive her hypoxic brain damage.
Such an incident is unlikely to occur today in a well equipt OR, but attending to  abberrent  ECG tracings  in  normal patients  can still  be a dangerous distraction.  When anesthesia has to be given "in the field", the least used monitor is the ECG.
Logged

ouraiby

  • Newbie
  • *
  • Posts: 2
    • View Profile
Re: ECGs for everybody?
« Reply #11 on: June 26, 2005, 06:26:13 AM »

I AM  REALLY  SURPRISED WHEN I KNOW THAT SOME ANESTHESIOLOGISTS DON'T CARE OF THE USE OF  ECG MONITORING AS A ROUTINE AND USED TO DEPEND ON PULSE OXIMETRY WHICH HAS MANY ARTIFACTS AND FALSE READINGS ESPECIALLY DELAY IN DETECTION OF HYPOXIA.TO ME IT IS MANDITA RY TO USE ECG MONITOR FOR ALL PT'S EVEN HEALTHY ONE OR FOR SHORT PROCEDURES.
Logged
Pages: [1]
« previous next »