Help with telemetry

[owen_osh]

Hi

I'm doing a sub-I in internal medicine. I'm following a pt with cardiac telemetry.

I've never been sure what I should be looking for with telemetry patients. I usually review any alarms overnight. My intuition is that a few random pvc's are no big deal. I guess I would be worried about runs of pvc's.

What other findings should be worrying or reassuring?

Thanks
Mike

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[remedios]

Hi

I'm doing a sub-I in internal medicine. I'm following a pt with cardiac telemetry.

I've never been sure what I should be looking for with telemetry patients. I usually review any alarms overnight. My intuition is that a few random pvc's are no big deal. I guess I would be worried about runs of pvc's.

What other findings should be worrying or reassuring?

Thanks
Mike

depending on the context. runs of pvc can be concerning as they may signify ventricular irritability. in general, you can expect to see some pvcs post-mi; however in someone with know arrythmias or history of (e.g., VT, but also for some pts with a-fib/flutter), lots of PVCs can mean that pt needs better membrane stabilization (check lytes, consider amio etc...)

other things i find helpful on tele:
1. the machine calculate rate from beat to beat basis, so the number displayed in alarm is often only reflexive of one beat; when in doubt, calculate the rate from total number of big boxes (1 big box=1s).
2. know what artifact looks like!!! (short rule of thumb: if one leads show vt-like squiggles and another one shows normal qrs, the squiggles are almost always artifact)
3. don't forget to quickly peak at the hr trent (an issue for pt who are placed on tele for rhythm monitoring; or in whom you are adjusting nodal blocking agents)

with practice you should be able to click through most tele monitors in under a minute per pt, unless something interesting pops up.

good luck on your sub-i!