- What is StripTease all about?
- Who does the analysis, and should I trust them?
- What browsers/devices work?
- What if the strip loads slowly so I only get 5 seconds to see it?
- What do the stars/ratings mean?
- What is this ‘gain’ thing?
- How best to learn?
- How can I follow a case?
- Why is the site so dang slow?
What is StripTease all about?
For an overview of intended use, target audience, and how to use StripTease, check this out.
I’m tony. I’m a surgery intern, and I’m fascinated with EKGs. I’m also fascinated with critical care. The confluence of those two is advanced 12-lead interpretation (for which there are zillions of excellent sites) and monitor interpretation, which is a subset of 12L interpretation with different capabilities and goals. There are probably plenty of good monitor-interpretation sites out there as well, but I appreciate the opportunity to put my favorite strips online, plus- its my own website so I can say “EKG” instead of “ECG” and sound like a really edgy dude.
I have a prehospital background, and remember what it is like to see the first 10 seconds of monitoring in an ill patient in the field. I also like to be able to nail the most important parts of a rhythm quickly in code situations, during pauses in compressions, and in the operating room. For that I need practice problems, and this site is my best attempt at creating that resource for myself and others with similar interests.
The content of the page is all mine, as are the strips (collected from a variety of settings since I was first regularly seeing EKGs). As this is tricky stuff and there is much yet to learn I ask experts to read over my stuff before I put it online, but that is no guarantee of perfection for a variety of reasons.
Please see the disclaimer for a little more discussion of my review process and the shortcomings and potential of this kind of site.
As of the last time I checked, it works perfectly with new versions of chrome, firefox, and internet explorer on mac and PC. Some older versions really botch things, though.
The zoom function (which is critical) does not work properly on on an iPad (in chrome nor safari), unfortunately. StripTease is especially lame on a smartphone, but just as well since the ergonomics of looking at tiny rhythm strips is all wrong.
Hit the ‘reload’ button on your browser before the page redirects you to the case analysis. You’ll get another 15 seconds.
Cases are rated with stars at the bottom of each page. Admittedly, this is fairly arbitrary. However, my rough intention is that everybody interested in this stuff should get a correct gestalt for the one-star problems. Two-star problems are standard fare but you will have to use some brain cells. Three-star problems will only go quickly for the highly-trained among us. When I rate the cases, I am really rating them based on the core findings. Ie: if it is sinus rhythm, it is a one-star strip, unless it is tricky to tell it is sinus rhythm. Then it is a two star strip. If it really looks like afib with a LBBB but is actually sinus rhythm, maybe it’s a three star strip. Many ‘simple’ strips have complicated findings which are discussed in the analysis, but those complicated findings are rarely of immediate clinical significance in a rapid response situation.
Three star strip. Devious stuff.
We are used to seeing a standard 12L with 10mm per 1 mV voltage calibration. Go bone up on this and how it is recorded on every 12L if you are not already familiar with it. This ‘standard’ calibration would be a gain of 100%. It is a calibration box that is ten small boxes high.
The reason this is mentioned so often on StripTease is because the monitors’ gain is all over the place, for various good and bad reasons. And because the amplitude of the various EKG deflections is clinically important- if the gain is turned way down you need to interpret the strip with that in mind. A gain of 40% is when the 1 mV calibration is only 4mm high, or 4 small boxes high. Gain of 160% is when it would be 16 boxes high. The waveforms would look 160% bigger than we are used to seeing them.
In terms of picking cases, I would just go down the list on the homepage. The cases are arranged randomly, as real patients are. I have not categorized them by type of case/arrhythmia/etc because if you are looking for a reference or for examples there are far better sites. I highly suggest you do not flip from case analysis to case analysis (thereby skipping the 15 second ‘test’) because you deprive yourself of an opportunity to practice your rapid interpretations of undifferentiated strips. That hard thinking is what prepares your brain to learn something.
Another reason to go down the list in order is that as the strips progressed, I often got bored with rewriting “PVCs are bad, and here’s why..” on every strip with a PVC, and if you are going in order you will find the explanations appropriately tapered as we progress together.
If you have already banged out all the cases, there are enough so that you can flip through random cases (see the link on the right) for a quick fix.
How could I help out?
Far and away the thing that would be most helpful is a couple of expert reviewers who would overread little packets of strips and analyses to make sure I’m on track. I could forward a link to a few cases before they are made public and you could let me know if I’m barking up the wrong tree. Other than that, there are a few other things you could do if you want to lend a hand, but no big deal.
Where should I go to learn more?
StripTease is not a good site to learn the basics, nor does it have any reference material or categorization. It is not a good resource for 12L interpretation. For those things there are zillions of excellent online resources. A very incomplete list of my favorites can be found here.
If you do a case and comment on it, you will be given the option to follow. This means that if anyone replies to your comment you will get an email. Currently there is no way to follow a case (so as to see if it is updated or if anyone else comments on it) without commenting yourself. This will hopefully get fixed in due time.
I pay a web server to host the site, but I’m not making any money so I only pay for the cheap-bastard plan. This site (and some other stuff I have) unfortunately gets enough traffic that I max out the available bandwidth I am allowed, and the server chokes up. In especially heavy moments of traffic (like after tweets with the site link from very popular entities) the traffic is so heavy it temporarily shuts the site down. There is nothing much you or I can do about this unless you want to find me an extra 30 bucks a month. For now, we all need to be patient. My apologies!
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