12-Lead EKGs

Well I would call up to 11% significant, not useless... Perhaps, I am misinterpreting that data. However, put your father with 10 other fathers and then tell me yours doesn't deserve to have the cath lab activated. That is why the cath lab is there; that is why we do half of what we do against the odds. Better to activate them and not need them. I don't want to dive off into tangents, but I can think of plenty of other cost saving measures that should be implemented before foregoing the activation of a team who's sole purpose it to do this kind of work.

So while I can see that we are going to fundamentally disagree on this issue (which really doesn't matter) it is important that prehospital providers are able to do the simple math on this, minimum competency if you will... If they see this- it is BAD. Being taught to ignore AvR or that its probably nothing is the wrong road to go down. Fact is... basically, if it's not a ST elevation MI then don't worry about it as much. The heart is our nations number one killer, from triple vessel disease to LMCA occlusions and everything else.

Potato po-tot-o... These patients are not going to benefit at all unless we get on the same page recognizing a lethal problem. I'm in my camp, you're in yours; we can agree, at least, that our patients would be better off in the hands of the cardiologist sooner rather than later. Sure, they've dumbed it down to ACS is ACS, but a good provider should be a little more knowledgeable on the subject, as you are.
 
My parents recently moved back into my EMS system's jurisdiction and my father just turned 83. If he contacted 9-1-1 at 0330 Sunday morning with an ECG like this (especially depending who was on call) I would just assume they treat him medically and re-assess. Make no mistake, if they were unable to control ischemic symptoms medically, I would want my father to go urgently to the cardiac cath lab. We're only nitpicking as to whether or not this should be an automatic prehospital cath lab activation. That's not to say it's an unimportant conversation. It's a reasonable area of disagreement on a controversial topic.
 
I used to teach the aVR thing, but have backed off on it. Nowadays I say to worry if it's in the setting of a very sick-looking patient with a picture consistent with ACS, where I think the predictive value may be reasonable, but to realize that (like most things) it's not a pathognomonic "gotcha."
 
Brandon O said:
Nowadays I say to worry if it's in the setting of a very sick-looking patient with a picture consistent with ACS, where I think the predictive value may be reasonable, but to realize that (like most things) it's not a pathognomonic "gotcha."
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This. Thank you.
I guess it's my fault for phrasing it wrong. I mean in the sense of a whole picture type of assessment, and not based on the single finding alone. I will still include it in my report, however. I was not very clear when I got up on the nit-picking. In the whole wiz-bang ACS scenario where the guy fits the bill (looks like crap, has pain, etc.) and has the depression and AvR elevation instead of just the ST elevation our schools taught us to look for exclusively. I'll wake them up and won't feel bad; they are well compensated That is what I'm getting at. Again, sorry if that was unclear.
 
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