Firstly the disclaimer. I have received no financial incentive to write this post. This is not an endorsement in any way from the North East Ambulance Service NHS Trust, but is solely the opinion of one blogger, namely little ol me! I decided to write this as I believe that as professional pre-hospital clinicians, we owe it to our patients to know as much as possible about their cardiac abnormalities and how they can present on our ECG monitors. Anything that can help raise the standard of care offered to our patients is worth spending some time on in my book.
I was contacted by a company recently called Pace Symposia. They are the developers of a newly launched ECG simulator, and they asked if I would look at their software and post a review on it. They have also asked some other bloggers for their reviews and these can be found here and here.
So, a little about the software first.
This is a rhythm simulator to help all who want to, further their knowledge of basic and fairly advanced ECG rhythm interpretation. Most of the simulators I have seen and used in the past all seem to have the same sort of rhythms on them and all seem to tread the same sort of path. Pace Symposias software is a little different though. As well as having all of the usual suspects in the ‘select rhythm’ section, the choice extends to some of the more rare and interesting abnormalities that you may see. For example, the screen shot below shows the rhythm of an A-V sequential pacemaker!You can also see from this screen shot, some of the choices you have for different rhythms. Another interesting and rather cool feature of this software, is the ability to add ectopic beats to the rhythm you are looking at. For example, the screen capture below shows an ST depression rhythm, but with added multifocal ectopics within the trace:
It allows you to freeze the action on the screen and brings up a handy grid to work out your timings and intervals :
However, one of the best things about it, is the variability of the software. You can change the rate of the rhythm, add in unifocal or mutifocal ectopics. When you begin to go into the various heart blocks, you can change the ratio of the block to suit what you want to learn. There are some things in here that are so rare, you would be fortunate to see them on the road, for example Atrial Fibrilation with Wolf Parkinson White syndrome :
All in all, I personally think that it is an invaluable addition to any providers learning tools. It does give so much more than other ones I have seen and used (but I may not have seen all the competitors out there!).
The company have stated that this is version 1.0, and further developments are on the way, so I am putting my wish hat on now and could suggest a couple of improvements if it were at all possible.
- Like all simulators, over a very quick period of time, you can learn to recognise a rhythm on the screen just through repetition. As soon as the first couple of beats come on the tracing you recognise it because it always looks like that. It would be a real unique selling point if there was some way that the patterns and rhythms could change slightly and randomly just like we see in individual human ECGs
- To follow on from point 1, and to stop people just learning parrot fashion, why not have a function where you can freeze the rhythm you are looking at and actually have a tutorial that teaches you about the rhythm and WHY it looks like it does on the screen. That way learners can actually develop their methods of analyzing rhythms based on knowledge about the physiology of the heart in direct correlation to the way the ECG trace looks.
- If you are going for realism, then lets have some artifact and wandering baselines that can be added on to the rhythms too.
- I know this one is pie in the sky, but it would be wonderful if you could pick a rhythm, look at it, then get a twelve lead trace to examine too.
So, thats it folks. I certainly think its worth a look for you to make your own mind up. Pace Symposia has set up a website for the software at ecg simulator.net, where you can try an online flash based version and download a fully functional free trial version. If you do have a go at it, post a comment and let me know what you think and I will feed it back to the company.