Difference between EKG and telemetry?

Hi,

We had a pt on my floor who I believe was on tele and we weren't aware he had an MI until an EKG was done which showed MI. He had shortness of breath, which is a symptom of MI. Was the tele tech asleep or EKG more accurate? Should an EKG be done automatically if someone is short of breath to rule out MI (if respiratory illness is not suspected)?

Thanks.
EKG is definitly more accurate!At least for my tele floor, our regular telemetry monitoring uses 5 leads, and the monitor shows a max of 2 leads at a time. Depending on where in the heart the MI occurs, it may not be visible on regular monitoring. We do 12 lead EKGs, so it shows 12 views of the heart at the same time. The EKG machine will do measurements and print on the page if the rhythm is NSR, abnormal, BBB, if there is any ST elevation or depression, etc. The cardiologist has to go over it it as well, of course.We have standing orders to perform an EKG prn chest pain and notify the MD, but there have been those times we've had a gut feeling and done one anyway, and have gotten the order later. Doing an EKG for a pt who becomes suddenly SOB (without the order to) would depend on the policies at your facility; any standing orders you may have, etc. Maybe talk to your charge and make a nursing decision that way. Perhaps you could even get a policy/practice guideline changed or added or just have a standing order created for any cardiac patients who present with acute SOB?(sorry this is all over the place, My sleep schedule is really messed up for some reason :P )

What did you see on the EKG?Remember that a 3 or 5 lead EKG will only look at the heart from so many angles. Acute SOB is indeed a symptom of an MI. What was he in for? What happened to your pt? Cath lab immediately?

telemetery or wired monitoring will only be 3 or 5 lead vs the routine 12 lead ecg and additional views that you can do with a 12 lead ( e.g. V4r or full Right sided 12 , posterio views '15-lead' (v7-9)... )

EKG is diagnostic, telemetry is only for monitoring of rhythm changes.

Hm, this is good information. Once again, I learned something new on this board.

As already stated an EKG is a more complete picture of the heart's electrical activity than a 3 or 5 lead telemetry monitor. It shows changes in the particular area of the heart where ischemia is happening. But we learned "treat the patient not the monitor". I have had patients code without monitor changes (PEA) and this can be particularly challenging if a patient is paced... (you can't see ST segment changes). You are the one with the patient, not the tele tech. Assessing and responding to signs of an MI are your responsibility. I had a woman code with an MI and her only symptom was nausea. You have to look at the whole patient picture. (She was a diabetic with a cardiac history, their MI presentation is more subtle, less classic CP.) If someone is SOB an EKG may be warranted, but not mandatory especially if you have another underlying cause to explain the SOB. Happy monitoring!