This month's education evening from BASICS Dorset was a "Masterclass in ECG Interpretation" delivered by Dr Hesham Ibrahim.
Victims of heart attacks and other Acute Coronary Syndromes (ACS) rely on the ability of the ambulance service to correctly record ECGs and identify the signs of injury to the heart.
Most ACS is caused by narrowing or blockage of the small coronary arteries that supply blood to the hear itself. Modern paramedics play a vital part in detecting the early signs of ACS and referring patients to hospitals with appropriate facilities to treat the blockage.
In the UK, the gold standard is for a patient suffering a major heart attack (am ST-elevation Myocardial Infarction or STEMI) to receive Primary Percutaneous Coronary Intervention (PPCI) to unblock the artery at an appropriate centre (called a "cath lab") within 2 hours. In addition to rapid diagnosis and transportation, emergency clinicians can start treatment to reduce to impact of the blockage. They also need to be on standby for resuscitation and defibrillation on the journey to hospital.
Dr Ibrahim is an NHS consultant in Emergency Medicine just over the border in Hampshire. As well as his usual practice in the Emergency Department, Hesham has taken the science of ECG interpretation and education to a new level. He is the founder of the Emergency Physicians' ECG Course (EPEC) which hosts online and taught sessions (both in the UK and internationally) to spread his knowledge using real cases and examples.
The audience consisted of paramedics, ambulance crew, nurses, doctors, community responders and students from across Dorset and Hampshire. Dr Ibrahim opened the session at Westbourne Baptist Church Hall with a review of the pathophysiology of ACS and how it causes changes in ECG recordings. He developed this on to the recognition of STEMI and ACS in a pre-hospital ECG recording with emphasis on some of the pitfalls (such as low voltage traces) that can mask a potential diagnosis.
The lessons continued apace as Hesham delved further in to his recording collection to show how the culprit artery can be identified from the ECG trace. Although initially taken as merely an interest point, the latest advice from the Euorpean Society of Cardiology (ESC) is to tailor emergency treatment depending on which part of the heart is damaged. A lively debate ensued around current clinical practice at which point it was decided to have a quick social break.
Having topped up the sugar and caffeine levels, it was time for some more developments in emergency cardiology. Again using ample examples and case notes, Dr Hesham talked the audience through some of the more subtle signs of occult or evolving myocardial infarction - namely de Winters Sign and Wellens Syndrome. The evening was rounded off with a discussion of current treatment pathways and a "Spot the STEMI" quiz using Hesham's vast portfolio of ECG recordings.
Plans are already in place for next month's session which will feature ALS revision and scenarios for students about to undertake clinical assessments.