The document outlines different types of crisis alarms that can occur during cardiac monitoring: true, false, and unconfirmed alarms. Section 1 describes true alarms as those correctly identifying a lethal arrhythmia based on at least two clearly measurable waveforms. Section 2 describes false alarms as resulting from incorrect arrhythmia interpretation due to a technical issue, with the underlying rhythm visible on at least two leads. Section 3 describes unconfirmed alarms as those with less than two clear waveforms, preventing confirmation of the rhythm.

1. Crisis Alarms
Rev. II
Drafted by
C. Schneider
July 2014
Draft Copy
Crisis Alarms Rev. II: Covers Outlines C. Schneider 7/2014

2. Crisis Alarms
Section 1 – True Crisis Alarms
o True Crisis Alarm Summary
o True Crisis Alarm Examples with Documentation
o Pause (Paced)
o Pause
o V Tach
o Asystole
o VFib/VTach
Section 2 – False Crisis Alarms
o False Crisis Alarm Summary
o False Crisis Alarm Examples with Documentation
o Pause
o V Tach
o Asystole
o Pause (Paced)
o VFib/VTach
Section 3 – Unconfirmed Crisis Alarms
o Unconfirmed Crisis Alarms Summary
o Unconfirmed Crisis Alarm Examples with Documentation
o Pause
o VFib/VTach
o Asystole
o V Brady
o V Tach
Section 4 – Practice
o Crisis Alarm Practice Sheet Example
o Practice Sheets for Crisis Alarm Measurement & Documentation
o True
o False
o Unconfirmed
o Uncommon
Crisis Alarms Rev. II: Covers Outlines C. Schneider 7/2014

3. o Section 1 - True Crisis Alarms
o What is a True Crisis Alarm?
• An alarm that is correctly interpreted as a lethal arrhythmia by the monitoring equipment
• Usually has a preceding baseline rhythm which is followed by an alarm rhythm
• Is usually facilitated by a run of 3 or more consecutive - ectopic beats
• Can be a Sinus Pause of 3 seconds or greater, rhythm conversion to Asystole of 6 seconds or greater
• Can either be a finite or sustained arrhythmia
o Verification of Alarm Status (T, F or U) -
• Requires a minimum of 2 or more clearly - measureable waveforms from separate leads
• Requires physical access or clear view of the patient to confirm their condition
• Does this type of alarm meet either of the above conditions? Yes, the alarm is True
o Documentation of True Crisis Alarms -
• Is an acknowledgement of the alarm occurrence & proper staff notification
• Reflects all EKG measurements & rhythm interpretation of the patient's baseline rhythm
• Reflects all EKG measurements, rhythm interpretation & number of beats (if any) in the proceeding alarm rhythm
• Will reflect the duration sinus pause or Asystole in seconds or "Sustained" in the alarm rhythm portion
• Is primarily based on what is shown within the event window
o Characteristics of True Crisis Alarms can include -
• A baseline rhythm followed by an alarm rhythm or sinus pause which are clearly displayed in at least two or more leads
• A sustained lethal arrhythmia, without a baseline rhythm, which is clearly displayed in at least two or more leads
• Any alarm rhythm such as Pause (sinus pause), VFib/VTach, VTach, VFib or Asystole
o Some True Crisis Alarms require the notification of a medical emergency team (AMET/CMET)
• A true Pause of 3 seconds or greater, Asystole or 6 seconds or greater
• A true crisis alarm with 15 or more consecutive beats of NCT or WCT
• Sustained VFib, VTach, Torsade's de Point or Asystole
• If you are unsure, notify a Lead Tech Immediately
① - Based on Current CMU, 'Lead Tech Notification' Policy as of 2014
Baseline Rhythm Alarm Rhythm
Crisis Alarms Rev. II: Covers Outlines C. Schneider 7/2014

4. o Section 2 - False Crisis Alarms
o What is a False Crisis Alarm?
• An alarm resulting from a false interpretation of a lethal arrhythmia by the monitoring equipment
• An alarm that can be verified because it always has two or more clearly measureable waveforms
• Is usually facilitated by an underlying technical issue
• Can be regarded as a False Alarm because it meets at lead one verification condition
o Verification of Alarm Status (T, F or U) -
• Requires a minimum of 2 or more clearly - measureable waveforms from separate leads
• Requires physical access or clear view of the patient to confirm their condition
• Does this type of alarm meet either of the above conditions? Yes, the alarm is False
o Documentation of False Crisis Alarms -
• Is an acknowledgement of the alarm occurrence & proper staff notification
• Reflects all EKG measurements, rhythm interpretation & likely cause of the alarm
• Likely causes are Likely Artifact, Likely Lead Fail, Likely Low Waveform Amp or False
• Does not require a 6 second post alarm strip
• Is primarily based on what is shown within the event window
o Characteristics of False Crisis Alarms can include -
• An underlying rhythm with the cause of the alarm are clearly displayed in at least two or more separate leads
• An underlying baseline rhythm which can be accurately measured & interpreted in at least two or more separate leads.
• Any false alarm with a corresponding justification or likely cause
o Initial Troubleshooting Solutions can include -
• Relearning the monitor during event
• Replacing worn leads
• Increasing waveform amplitude - size or gain
• Repositioning leads away from bony or hairy areas
• Setting pacer detect to Pace 2 on GE Monitors followed by Relearning
• Single Lead Monitoring, which may apply on Paced or VAD patients
Crisis Alarms Rev. II: Covers Outlines C. Schneider 7/2014

5. o Section 3 - Unconfirmed Crisis Alarms
o What is an Unconfirmed Crisis Alarm?
• An alarm that always has less than two clearly measureable waveforms
• An alarm resulting from a false interpretation of a lethal arrhythmia by the monitoring equipment
• Is usually facilitated by an underlying technical issue
• Can be regarded as True due to lack of verification
o Verification of Alarm Status (T, F or U) -
• Requires a minimum of 2 or more clearly - measureable waveforms from separate leads
• Requires physical access or clear view of the patient to confirm their condition
• Does this type of alarm meet either of the above conditions? No, the alarm is Unconfirmed
o Documentation of Unconfirmed Crisis Alarms -
• Is an initial acknowledgement of the alarm occurrence & proper staff notification
• Reflects only the metrics that are clearly shown on the monitor screen
• Have no documentable "likely cause"
• Requires a 6 second post - alarm strip interpretation after the alarm takes place
• The 6 second strip must have at least 2 clearly measureable waveforms from separate leads
• Is primarily based on what is shown within the event window
o From a documentation & safety standpoint, this type of alarm cannot be proven true or false because
• Unconfirmed Alarms will always have less than 2 clearly measureable leads
• The patient & their symptoms (or lack of) cannot be seen from a remote/satellite monitoring environment
o Characteristics of Unconfirmed Crisis Alarms can include -
• Less than two EKG waveforms being present
• Excessive artifact being present in one or more leads
• True or false alarms which cannot be justified with any degree of certainty
o Initial Troubleshooting Solutions can include -
• Relearning the monitor during event
• Replacing worn leads
• Increasing waveform amplitude (size or gain)
• Repositioning leads away from bony or hairy areas
• Setting pacer detect to Pace 2 on GE Monitors followed by relearning
• Single Lead Monitoring, which can apply on Paced or VAD patients
Crisis Alarms Rev. II: Covers Outlines C. Schneider 7/2014