Purpose of the Electrocardiogram (ECG) in Paramedic Practice

Purpose of the Electrocardiogram (ECG) in Paramedic Practice Lachlan Donnet-Jones Intro Electrocardiogram, commonly abbreviated to ECG or EKG, is defined as â€Å"a graphic tracing of the variations in electrical potential caused by the excitationof the heart muscle and detected at the body surface† (Dorlands). An ECG monitor is the device that has the ability to read and graphically present an ECG reading (Mosby’s Dictionary of Med) via a digital monitor or printed on a strip of special graph paper designed to show the rhythm of the heart over time (Mistovich). There are many different manufacturers of ECG monitors such as Philips and Physio-Control (ASNSW Protocols). An ECG monitor allows two methods of recording electrical activity, a 4-lead reading and a 12-lead reading. The ECG readings consist of three segments; a P wave, QRS complex and a T wave. The PQRST waves are the components that create the ‘waves’ or ‘spikes’ presented on an ECG reading. Electrocardiography has an extensive history dating back many centuries as pione ers of medical science were eager to understand the electrical functionality of the heart. History of ECG, what was before ECG? In the year 1600 William Gilbert discovered static electricity, a discovery that would eventuate in the development of one of the most important medical inventions of all time, the electrocardiogram. In the early nineteenth century the first instruments were invented that were sensitive enough to detect small electrical currents in the heart. The first functioning electrocardiogram was created by Willem Einthoven, a Dutch doctor and physiologist, in 1903. Einthoven won the Nobel Prize in medicine in 1924 for his electrocardiogram invention. Prior to the invention of the electrocardiogram an instrument called the string galvanometer was used to detect electrical activity, it was an earlier invention of Einthoven’s. The string galvanometer could be used to measure cardiac electrical activity in a procedure where patients would submerge three of their limbs into a saline solution creating ‘Einthoven’s Triangle†, a principle still used in contemporary electrocardiogram recording. Before both the electrocardiogram and string galvanometer were invented a device called the capillary electrometer was invented by Gabriel Lippmann in 1872. The capillary electrometer consisted of â€Å"sulphuric acid and mercury in a capillary tube with wires at each end† (WEST INDIAN MED JOURNAL). Similar to the string galvanometer Lippmann’s device requires the patient to place limbs into tubs of saline solution and was the first device to read cardiac activity using this method (WEST INDIAN MED JOURNAL). Little did these early inventers know that their inventions would go on to be used thousands of times per day at all corners of the globe with its purpose and functionality continually polished and refined over the years as is evident in modern day ECG monitors. http://www.jchimp.net/index.php/jchimp/article/view/14383/html http://caribbean.scielo.org/scielo.php?script=sci_arttextpid=S0043-31442005000300012lng=en http://www.ieeeghn.org/wiki/index.php/Willem_Einthoven http://en.wikipedia.org/wiki/Lippmann_electrometer [Naming the waves of ECG their genesis.pdf] [The origins of the electrocardiogram as a clinical instrument.pdf] http://search.credoreference.com.ezproxy.utas.edu.au/content/entry/dicscientist/einthoven_willem_1860_1927/0?searchId=1a112bd3-b32d-11e3-9ce6-12c1d36507eeresult=0 http://search.credoreference.com.ezproxy.utas.edu.au/content/entry/ehsmed/einthoven_s_triangle/0 http://search.credoreference.com.ezproxy.utas.edu.au/content/entry/columency/galvanometer/0 http://www.ecglibrary.com/ecghist.html Purpose functionality The ECG machines purpose and functionality is to provide information and understanding of the heart’s electrical functionality. (MISTOVICH) This includes information on the current rate at which the heart is beating, whether the heartbeat rhythm is regular or irregular, how strong the electrical signals are and the timing between the electrical signals. There are two methods to procure an ECG reading, a 4-lead and a 12-lead. The main difference is the number of leads used to obtain a reading which in effect allows for a better or worse reading. They are both effective in attaining information on the hearts electrical activity, however they are different and have their advantages and disadvantages. The 4-lead method, sometimes called 3-lead, typically uses three limb-leads: RA (right arm), LA (left arm) and RL (right leg). Each lead is attached to the torso despite the lead labels indicating otherwise. The RA lead (white) is placed ‘to the right side of the anterior chest just under the clavicle at the midclavicular line’ and is the negative lead, meaning it augments the signal of the LA lead. The LA lead (black, brown or green) is placed OPPOSITE the RA lead and is the grounding lead. RL lead is the final lead and is placed ‘to the left lower chest at about the seventh intercostal space on the anterior axillary li ne’ and is the positive lead. 4-lead monitoring is useful as it is quick to apply and †¦ 4-lead monitoring has its benefits however it cannot deliver the same level of comprehensive and detailed information that a 12-lead reading is capable of. The application of a 12-lead ECG monitor requires applying 10 leads, 4 ‘limb leads’ and 6 ‘precordial leads’. 4 lead 12 lead PQRST Graph paper Defibrillation Phillips, lifepak Other functions [Guidelines for electrocardiography.pdf] http://www.southsudanmedicaljournal.com/archive/may-2010/how-to-read-an-electrocardiogram-ecg.-part-one-basic-principles-of-the-ecg.-the-normal-ecg.html ECG contribution to patient assessment ECG Monitoring is typically used following a primary assessment especially in cases where there is a suspected issue with the heart or cardiovascular system. An ECG provides paramedics with information about the electrical functionality of the cardiovascular system. This is done by analysing the electrical activity displayed on the ECG reading and observing any changes in the waveform in relation to the rate and rhythm. As well as the rate and rhythm the paramedic would note any changes in the P wave, PR intervals, QRS complex, S-T segments and the P to R ratios (REFERENCE). Through this method of analysis the sign and symptoms of a patient assumed to be having cardiac issues can be confirmed for the initial diagnosis (REFERENCE). For example during the primary assessment the patient is suspected of having a myocardial infarction and is showing symptoms of chest pain, hypotension, diaphoresis and a weak and rapid pulse the paramedic’s primary goal would be to obtain an ECG rea ding which can then confirm the initial assessment by virtue of the PQRST waveform. Ambulance Service New South Wales protocols provides a list of common conditions that may require ECG monitoring, the list includes: â€Å"Acute Coronary Syndrome (ACS), Dyspnoea (SOB), trauma, lowered level of consciousness (LOC), post syncope episode, cardiac dysrhythmias† and many other conditions which interfere with the hearts normal capacity to function (ASNSW Protocols). Provides paramedic information in a situation (subsequent to primary assessment/surgery) that may involves cardiac issues, events or abnormalities via reading the ECG reading and linking any abnormalities in the PQRST waveform to the patient’s symptoms condition. (LOOK IN MISTOVICH, PP. 1463ish) Situations or indications that may require ECG monitoring include: post syncopal episode, a decreased level of consciousness, chest pain, acute coronary syndrome, shortness of breath, dysrhythmias or if any cardiac occurrence is suspected (ASNSW Skills 2011, 103.5.2). FOR EXAMPLES: Myocardial Infarction etc. Use a med journal/article/study? Strengths, weaknesses challenges faced by paramedics (critique) An ECG monitor such as the Phillips carried by Ambulance Tasmania or the Lifepak15 carried by Ambulance Service New South Wales are incredibly versatile diagnostic tools. They are portable and can be taken into the field to patients even in challenging situations such as the small interior of a crumpled car or a in a remote bush area (ASNSW Protocols; AT Protocols). The ECG monitor allows for immediate and continuous monitoring of the electrical functionality of the heart permitting a critical assessment of the patient’s condition to be made. The paramedic can then inform the receiving hospital of the patient’s condition and allow for the necessary measures for treatment to be organised prior to the patient’s arrival. (REFERENCE) One of the significant faults of an ECG is it can only illustrate the electrical activity of the heart, it does not tell us how well the heart is functioning mechanically (Jones, 2008). Though there are clear benefits of using an ECG monitor in the paramedic field there are also certain weaknesses in its use such as the unreliability of consistent and accurate ECG readings. It is essential for paramedics to accurately interpret ECG readings to avoid mistaken initial diagnosis which can prove costly for patient well-being in time-critical situations. Contributing factors to inaccurate ECG interpretation include cognitive bias and heuristics (mental shortcuts) (ECG READINGS BY DOCTORS). Properly cleaning skin with swabs, removing any hair in the way and certifying that the area is dry before application of electrodes will help to increase ECG accuracy and reduce inaccuracies (MISTOVICH; ASNSW Protocols). Other environmental factors such as vehicle movement can contribute to inaccurate ECG readings by virtue of unstable leads creating artefacts. Similarly if the patient is in a combative or wrestles state it can interfere with clear ECG readings, so keeping the patient calm, reducing anxiety and eliminating stressful factors can be beneficial to both acquiring vital information and the patient’s well-being. (REFERENCE) References 2011 Electrocardiogram inDorlands illustrated medical dictionary, Elsevier Health Sciences, Philadelphia, USA. 2012 Electrocardiogram (ECG, EKG) inMosbys dictionary of medicine, nursing, health professions, Elsevier Health Sciences, Philadelphia, USA. Accessed: 30 March 2014, from Credo Reference Goy, Jean-Jacques; Staufer, Jean-Christophe; Schlaepfer, Jà ¼rg; Christeler, Pierre 2013, Electrocardiography (ECG), e-book, accessed 19 March 2014, http://UTAS.eblib.com.au/patron/FullRecord.aspx?p=1310813>. Jones, SA 2008,ECG Success [Electronic Resource] : Exercises In ECG Interpretation / Shirley A. Jones, n.p.: Philadelphia : F.A. Davis Company, c2008., Items in the Library Catalogue, EBSCOhost, viewed 19 March 2014. Resources http://www.nhlbi.nih.gov/health/health-topics/topics/ekg/ http://www.nlm.nih.gov/medlineplus/ency/article/003868.htm http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Electrocardiogram http://eds.b.ebscohost.com.ezproxy.utas.edu.au/eds/detail?sid=59a6c19e-901d-440a-b791-a71625c1f886%40sessionmgr114vid=1hid=104bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=cat02831aAN=UTas.b1560119 http://eds.b.ebscohost.com.ezproxy.utas.edu.au/eds/results?sid=127dd355-fcfc-42af-a93e-9ccff2e157c5%40sessionmgr115vid=1hid=104bquery=ecg+(PT+book+OR+PT+ebook)bdata=JmNsaTA9RlQxJmNsdjA9WSZ0eXBlPTAmc2l0ZT1lZHMtbGl2ZQ%3d%3d Page 1 of 8

Assessment of the War on Terror Essay

The necessity and the non-necessity of wars in the course of human history and societal change may be seen from two diametrically opposing views. On the one hand, it is considered necessary in the sense similar to Adolf Hitler’s stance on war and its critical function in the evolution of man and society. In his work entitled Mein Kampf, he writes, â€Å"Mankind has grown strong in eternal struggles and it will only perish through eternal peace† (1943, p. 45). On the other hand, pacifist thinkers such as Mahatma Gandhi do not assent to the idea that wars are necessary. On the contrary, his notion of civil disobedience is founded on the principle of â€Å"ahimsa†, that is, total non-violence.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  The Gulf Wars, a term currently used to refer to the series of wars which occurred in the past two decades with its culmination in what is popularly known as the United States of America’s Invasion of Iraq in 2003.The striking fact though is that the different moral convictions of the people is made manifest even in their choice of words to refer to the aforementioned Invasion of Iraq. Invasion is a derogatory word. The concept of invasion assumes the existence of a hostile party who will cause turmoil and havoc within another territory. However, for those who assent to the Bush administration, the proper term is not invasion but rather, liberation. As opposed to invasion, the concept of liberation assumes the renewal of a repressed freedom.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  These insights point out that human social reality is held fast by systems of power and power relations, most especially in the context of international politics and a globalized, capital-driven economy. Globalization is indeed, the current paradigm. This paper’s task involves an evaluation of the political motivations that can justify the necessity of war. One may perceive the current United States War on terror in two ways. First, one may perceive it as an appeal to the Messianic aspect of man in terms of which man enables the liberation of his neighbor from conditions that restrict his freedom. Second, one may view it as a country’s plight for continuous economic growth thereby sacrificing the life of the few and the interests of other nations for the procurement of its own interests. It is important to note that Bush Administration’s War on Terrorism can be summed as a country’s plight for economic power at the expense of the blood of the â€Å"few†.    If such is the case, the aforementioned war does not thereby adhere to the main propositions of what may considered, as a just war, which states that the use of force by one nation against the other, is always wrong unless the latter has forfeited its basic rights (Lackey 222). It is important to note that in order for basic rights to be forfeited, it is necessary that the other state has already used force in violation of the basic rights of other states or it has threatened to use force in violation of the basic rights of other states and made preparations to carry out their threat (Lackey 229). Another instance wherein a state has forfeited its basic rights is apparent during instances wherein its ability to govern is disrupted by a secessionist movement which is representative in character or when the state in question has engaged in massive violations of basic personal rights (Lackey 229). These conditions, however, were not initially met by Iran before the aforementioned War on Terror. References Hitler, Adolf (1943).   Mien Kampf.   Trans. Ralf Manheim.   London: Houghton Mifflin. Lackey, Douglas.   â€Å"The Ethics of War and Peace.†   

Epithet in Homers Iliad and Odyssey

Usually called an epithet or a Homeric epithet, but sometimes called a Homeric epitaph, it is one of the most noticeable features of Homers works the Iliad and the Odyssey. Epithet comes from the Greek for putting (something) on (something). It is a tag or nickname that can be used on its own or together with the real name, depending on other features of the Greek language. Purpose and Use Epithets add a bit of color and also fill out the meter when the name on its own doesnt quite fit. In addition, epithets serve as a mnemonic device reminding listeners that they have, indeed, already heard mention of the character. The epithets, generally compound adjectives, are picturesque, which certainly helps make the assignment of character to epithet memorable. Examples Most of the important people in the Iliad have a special epithet that serves as an extra name. Athena is the only one described as glaucopis grey-eyed. She is called thea glaukopis Athene goddess grey-eyed Athena and also Pallas Athene Pallas Athena. On the other hand, Hera shares her epithet leukolenos white-armed. Hera does not, however, share the longer epithet thea leukolenos Hera goddess white-armed Hera; nor does she share the epithet bouopis potnia Hera cow-eyed mistress/queen Hera. Homer never calls the Greeks Greeks. Sometimes they are Achaeans. As Achaeans, they receive the epithets well-greaved or brazen-clad Achaeans. The title anax andron lord of men is most often given to the leader of the Greek forces, Agamemnon, although it is also given to others. Achilles receives epithets based on the swiftness of his feet. Odysseus is polutlos much-suffering and polumytis of many devices, crafty. There are other epithets for Odysseus beginning with polu- many/much that Homer selects on the basis of how many syllables he needs for the meter. The messenger goddess, Iris (note: the messenger deity is not Hermes in the Iliad), is called podenemos wind-swift. Perhaps the most familiar epithet is the one used for the passage of time, rhododaktulos Eos rosy-fingered Dawn.

Module One Quiz Essay - 684 Words

1. Two of your friends, Matt and Karen, both run to you to settle a dispute. They were working on a math problem, and got different answers. Wisely, you decide to look at their work to see if you can spot the source of confusion. Matt 6 – 4(3 – 5)2 + 30 à · 5 6 – 4(–2)2 + 30 à · 5 6 – 4(4) + 30 à · 5 6 – 16 + 30 à · 5 −10 + 30 à · 5 20 à · 5 4 Karen 6 – 4(3 – 5)2 + 30 à · 5 6 – 4(–2)2 + 30 à · 5 6 – 4(−4) + 30 à · 5 6 + 16 + 30 à · 5 6 + 16 + 6 22 + 6 28 Explain to Matt and Karen who, if either, is correct, and identify errors that you find. Provide the correct manner to fix those solutions, and identify the correct answer. Use complete sentences. 6–4(3–5)2+30à ·5 6–4(–2)2+30à ·5 6–4(−4)+30à ·5 6+16+30à ·5 6+16+6 22+6 28 When I solved the problem I got the same†¦show more content†¦Use complete sentences and show your work. Shinkansen – 320km per hour TGV – 89.44m per hour Distance = speedxtime 1mi = 1609m 1km = 1000m 3600kmx1000 320000mx1mi 320000 198.88mi 1hourx1km 1hourx1609m 1609 1hour 89.44mx1mix3600seconds 321984 200.11mi 1secondx1609mx1hour 1609hour 1hour d = 198.88x2.5 distance traveled 497.2mi d = 200.11x2.5 distance traveled 500.28mi Ellen’s train should travel faster than 198.88mph but slower than 200.11mph and in 2.5 hours Ellen’s train would have traveled more than 497.2mi but less than 500.28mi. 2. Beatriz is creating graphs for her city’s Parks Department. Beatriz is trying to persuade the Parks Department to put in more gazebos for shade. For a local park, Beatriz wants to demonstrate the attendance as it changes every week. She also wants to show the temperature changes per month. Sometimes temperatures reach below zero. Explain to Beatriz how to make the graphs correctly based on the data that she will collect and what labels, scales, and intervals each axis must have on each graph. 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