1-2 seconds!

Life threatening arrythmias should be quickly interpreted - VT, asystole and VF should be apparent in seconds. The scenarios would potentially have nurses pre-determining that you were going to show them something life threatening so they are already pre warned. In a real situation it may take a few seconds to realise something isn't right then a few more to actually decode then respond. A rhythm strip is different to an ECG ie 12 lead, so the terms need to be clarified. Best wishes for your research.

A further response, I was thinking the patient's were already being monitored hence my comment on rhythm strips/monitoring. A quick response for immediately life threatening arrythmias would preclude taking an ECG. The clinical signs for VF/asystole would be apparent before taking an ECG. VT may be recordable on a 12 lead ECG if the patient is still conscious. What scenarios are you trying to create? What are the qualifications of the nurse ie. are they in a critical care area or more generally orientated?  Response time will vary depending on the skills and knowledge of each nurse. 

Hi Becky,

Thanks for your responses.

Two things: 1) I have noticed that, when talking about interpreting life-threatening arrhythmias on an ECG, you have focused on cardiac arrest rhythms (which by the way would be much easier to detect - you don't really need an ECG). I think this the consequence of me not clarifying that I was talking more about any cardiac arrhythmia that could potentially lead to fatal circumstances if undetected by nurses during their ABCDE assessment of the patient (Bradiarrhythmias, Tachyarrhythmias, Blocks...); and 2) I will be assessing inexperienced general nurses and/or nursing students after a training session in 'Basic ECG interpretation'. I will be giving scenarios with different clinical presentations and an associated Lead-II ECG strip (FA, SVT, Atrial Flutter, Mobitz Type I and II, etc). They will also be instructed to follow the six-stage approach.

I think it's unrealistic to think that they will identify the rhythms immediately, but I wouldn't want to give then as much time as they may like and may not have in real clinical practice. I thought that maybe 2 minutes for scenario would be a reasonable amount of time given the situation, but again I wanted to know what other researchers/practitioners thoughts were.

What do you think?

Many thanks.

Hi Jose.

Yes I think both Przemyslaw and I both thought of the more serious rhythms. I understand your terms now. Yes, any arrhythmia can be life threatening depending on severity and lack of diagnosis .

I think it is hard to put a time on it given each person's experience. I would like to think a bradycardia, tachycardia  and AF is easily identified but in my experience Mobitz and complete blocks are not so easily identified. Having spent hours/years/decades on teaching students, some get it faster than others, some don't get it at all.

Perhaps you can choose a group at random and do trial run as a pilot?

Best wishes,

Becky

Hi Jose,

about your question I think that L-II ECG strip should be interpreted in no more than 10 seconds. This is the time needed by an AED to determine if a electric therapy is necessary or not. This is the standard we require to our EMS nurses. Other institution, for instance, prefer to apply AED or to perform ECG interpretation with automatic system (i.e.: Marquette 12 SL). Bye Fede

Hi Becky and Federico,

Thanks for your responses. I appreciate your advice. Will keep you posted with the outcomes.

Best,

Jose

Hi Jose,

Since this is a Basic beginners class and not an advanced class, I would try doing a couple "games" and give them 10-15 seconds.  See how many can get the answer correctly and you will be able to evaluate their understanding prior to give the actual quiz.  Students can sometimes get overwhelmed with looking at too many things at once when first learning and thus lose the focus. This may be a way to get them on the right track. Make it fun - they will retain more!

Good Luck,

Melody

Thanks, Melody.

That is the intention. We are delivering a training session following a student-centred approach and, by the end of it, we will be assessing whether they have acquired the competence. So that is the plan: to let them have some fun and then assess them.

There is disparity as to what should be the benchmark to determine when an individual is competent or not to detect a potentially life-threatening arrhythmia (should it take them 10 secs or 1min?). Thus, the question I formulated. I wanted to know whether I could set a benchmark on a non-arbitrary fashion (Perhaps following some kind of general mantra / guidelines?)... I am not sure I have succeeded on finding that. However your answers have been very helpful. Everybody seems to agree with the fact that the delegates must be FAST. Let's see...

Best,

Jose