Skilled Cardiac Monitoring at the Bedside: An Algorithm for Success

You are a nurse working in an intensive care unit (ICU), and your patient, a 62-year-old man, has just arrived from the operating room after a cholecystectomy. He is sleepy but arousable and says he has some incisional pain. You start cardiac monitoring with lead II, as is the practice in your area. One hour later, the patient has ventricular fibrillation. After successful defibrillation, 12-lead electrocardiography (ECG) is done. The patient has ST-segment depression in lead III and 4 mm of ST-segment elevation in leads V₃ and V₄. You note that the patient’s history includes placement of a stent to the left anterior descending coronary artery 3 months before the cholecystectomy and that he had stopped taking clopidogrel 2 weeks before the current surgery. Knowing this information, would you have chosen a different way to monitor this patient? How would you decide what leads to monitor? Is...