A patient with Parkinson's disease presents with chest pain to your ED. Her tremors prevent you from getting a good quality EKG because of the movement artifact.
How can you eliminate this artifact? (No cheating with rocuronium.)
Trick of the Trade
Have the patient sit on his/her hands.
Although I haven't tried this myself, this trick apparently works for people with upper extremity tremors and movement disorders. Has anyone used this trick? It's been referenced in: Burdick E350 Operating Manual. Milton, Wis: Siemens Burdick, Inc; 1990.
Thanks to Brooke, RN for this tip, and Alex for being a hand-sitting model!
As a tech, I use this all the time in patients with tremors and have had decent success. It usually won't completely eliminate artifact, but it certainly reduces it a good deal of the time. Combined with a couple other maneuvers, you can end up with very readable tracings (or better) on patients who you'd have thought it impossible to obtain a usable ECG.
ReplyDeleteEven more than for tremors, I love to use this trick when the patient is fidgety (or, as you stated, has a movement disorder). In these cases it really is night and day between the giant baseline swings before and the nice smooth tracing after. A little light pressure on their legs (or just a heavy blanket to weigh em down), and all their leads will look pristine.
Ha, not bad. We usually have the patient with their arms at their sides or there are handles on the sides of the table for moving it. But sitting on them, haven't tried this yet for movement artifacts. Nice.
ReplyDelete@VinceD: Wow, thanks for coming up with another cool trick of using a heavy blanket to weigh down fidgety legs!
ReplyDelete@Doctor Lagrande: Happy to help. Thank our nurse, Brooke!
Thanks! With ECGs being one of my favorite things to do in the ED, I've accrued a bunch of tricks. The blankets play a double role if you have a warmer too by halting any shivering (which might not even be visible) and simply making the patient more relaxed. Even slightly tense muscles from something like the patient lifting their head will create a good deal of artifact, so even simple things we can do to get them to relax creates a notable difference in the tracing quality.
ReplyDeleteMeant to attach this blog post from ECG guru Tom Bouthillet where he demonstrates how much effect a blanket can have. Of note, the two tracings were only taken 68 seconds apart.
ReplyDeletehttp://ems12lead.com/2008/10/muscle-tremors-your-patients-dignity-and-staying-organized/
Wow I didn't know that Tom wrote about the blanket trick! Thanks for the URL link.
ReplyDelete