AED Pads for Conscious Patients?

I've seen 12-leads that had leads that looked like VT when a pt was shaking their arm or leg. I can't recall if it showed up in any of the precordial leads, which is what an AED would be looking at.
 
I still don't buy it. I've got a friend at Physio. I'll send him an email tomorrow. If anyone would know, it would be him. :)
 
My local protocol is to place pads on conscious STEMI patient. That being said, the monitor doesn't go into AED mode unless the patient codes.
 
wxemt said:
My local protocol is to place pads on conscious STEMI patient. That being said, the monitor doesn't go into AED mode unless the patient codes.
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The difference between someone having an MI and someone complaining of chest pain is vast. Requiring every STEMI to have pads placed is overkill, but far better than blindly placing them on someone who utters the magic words "chest pain."

It's kind of like giving everyone who says "pain" narcotics...but I digress...:D
 
wxemt said:
My local protocol is to place pads on conscious STEMI patient. That being said, the monitor doesn't go into AED mode unless the patient codes.
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I have yet to see an EMS monitor that switches to AED mode all by itself. There's monitor mode and there's AED/Defib mode. Some monitors even have "Pace" mode. Even the AED monitors have to specifically put into AED mode before they'll do anything other than show a rhythm.
 
Akulahawk said:
I have yet to see an EMS monitor that switches to AED mode all by itself. There's monitor mode and there's AED/Defib mode. Some monitors even have "Pace" mode. Even the AED monitors have to specifically put into AED mode before they'll do anything other than show a rhythm.
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Exactly. Outside of the cost of the pads, pre -applying the pads to an unstable STEMI patient really has no cons that I can see. This is of course assuming a proficient EMT.
 
wxemt said:
My local protocol is to place pads on conscious STEMI patient. That being said, the monitor doesn't go into AED mode unless the patient codes.
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Whats the justification to applying pads to every STEMI pt? Not every STEMI codes in the field or in the hospital for that matter. Seems like a waste to me.
 
CALEMT said:
Whats the justification to applying pads to every STEMI pt? Not every STEMI codes in the field or in the hospital for that matter. Seems like a waste to me.
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Not every STEMI patient codes, but those go into vfib arrest benefit from immediate defibrillation. Not exactly the same thing, but I would compare it somewhat to leaving the pads on after ROSC (i.e. in case the patient codes again).
 
wxemt said:
Not every STEMI patient codes, but those go into vfib arrest benefit from immediate defibrillation. Not exactly the same thing, but I would compare it somewhat to leaving the pads on after ROSC (i.e. in case the patient codes again).
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True, but what is the percentage of STEMI pt's that go into vfib during the time you have pt care? I'm not trying to argue, protocols are protocols. It just seems like a unnecessary protocol in my opinion.

Leaving the pads on after ROSC is different that placing them on an active STEMI. After all you did just shock the heart back into a rhythm, chances are fairly decent that the pt may code again. No guarantee that a STEMI will code on you during the duration of the call.
 
CALEMT said:
True, but what is the percentage of STEMI pt's that go into vfib during the time you have pt care? I'm not trying to argue, protocols are protocols. It just seems like a unnecessary protocol in my opinion.

Leaving the pads on after ROSC is different that placing them on an active STEMI. After all you did just shock the heart back into a rhythm, chances are fairly decent that the pt may code again. No guarantee that a STEMI will code on you during the duration of the call.
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Oh I definitely agree that it is likely unnecessary for 9/10 STEMI patients. I guess the powers at be see the cost of the pads as being out weighed by the potential benefit in the small percentage of patients that go into a shockable rhythm.

Question for others that have this same protocol. Do you also have CCR and CPR protocols? Both of these seems to be on the newer edge of things and I am just curious if these two sets of protocols typically exist together.
 
Even in the ER, STEMIs get pads. You have someone with a very unhappy myocardium which is more likely to go into a bad rhythm.
 
Yeah, I continue to put pads on every STEMI patient. Fortunately my agency doesn't seem to mind.
 
DEmedic said:
Over the last year I transported 5 STEMIs, 2 of them arrested. Pads may be expensive, but charging that LP and firing off the shock in just a couple of seconds... Priceless.
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Just out of curiosity, how have the results been?
 
Our defib pads are Multi Function Electrodes, used for defib, pacing, and cardioversion. The only times I've seen them put on a conscious patient were for things like SVT, or we had a conscious V-Tach patient a week or so ago who we put pads on but otherwise I can count the number of times on one hand I've seen the MFE's put on conscious patients in the last two years I've been here
 
redundantbassist said:
Just out of curiosity, how have the results been?
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I'm assuming you mean the arrests? Both resuscitated while en route. One coded repeatedly in the ED prior to PCI and could not be revived, the other made it to PCI and I heard he was discharged with a CPC 1. The other STEMIs I transported all made it into PCI (as far as I know).
 
AED = Automated External Defibrillator

Defibrillation and cardioversion are not the same thing. Put the AED on people in cardiac arrest. It's a pretty straight forward concept.

Not sure exactly how your system works, but if a person is getting nitro/ASA and has chest pain and has a low SPO2, there should probably be a paramedic (or at least a request for one) involved in the story somewhere. They can determine whether the conscious cardiac patient requires therapy pads applied or not.
 
SixEightWhiskey said:
Not sure exactly how your system works, but if a person is getting nitro/ASA and has chest pain and has a low SPO2, there should probably be a paramedic (or at least a request for one) involved in the story somewhere. They can determine whether the conscious cardiac patient requires therapy pads applied or not.
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I believe the system in this scenario is BLS first response, with transporting dual medics.
 
Flying said:
I believe the system in this scenario is BLS first response, with transporting dual medics.
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That's reasonable. I'd rather have the BLS do the other regular BLS stuff in that scenario though and have a good report ready for whenever they do get ALS, and then the medics can decide whether to put the pads on or not if they need to provide some sort of electrical therapy.
 
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