Anterior Ischemia or Syncope?

GoldcrossEMTbasic said:
The off duty cardiologist told the patient that there is a potential heart issue going on. And he told her that she needed to have further testing done. So to clarify something, if the monitor shows Anterior Ischemia is it a false reading or a confirmed reading? I know what a AI is. It is a lack of o2 to the front part of the heart, due to a blockage possibly atherosclerosis.
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The monitors use algorithms to interpret . They are suppose I be there to help and guide providers. The problem is they are usually wrong. If it spits out a stemi or acute mi it means nothing until I confirm it. In some systems the strip is sent to the hospital to be read. The machine doesn't diagnose. It is a tool we use in conjunction with a history and assessment to come to a diagnosis.
 
GoldcrossEMTbasic said:
Yes the 12 lead did show that. They did it in a private area on scene, not on the rig. The off duty cardiologist ordered the 12 lead. One side of the strip printed normal sinus and then I saw the Anterior Ischemia. Printed on the other side. Used on a Phillips Lifepak.
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The point we're making is that monitor interpretations of "Anterior Ischemia" or "Abnormal EKG Unconfirmed" mean basically nothing. Monitors can be okay at determining quantitative measurements of PRI, QRS intervals, and axes, but rhythm interpretations and ischemia detections are notoriously inaccurate. This is why we still have doctors interpret rather than machines.


Also, the bystander cardiologist didn't have to "order" a 12 lead for the responding ALS crew to do one.


GoldcrossEMTbasic said:
Yes, she was refusing, The medics were wanting to leave, this agency had a really busy day. But It took the pastor and the doctor to get her checked out. Not the ALS crew.
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In the future, you might want to clarify that the patient initially refused and then changed her mind. This wording is slightly confusing, as patients who continue to refuse aren't transported unless there's a legal hold placed.

I think the main point I'd like to make here that others have mentioned is that we can't have any idea what is going on. Any one of a number of things could have caused a syncopal episode, and having a non-diagnostic 12 lead with automated "anterior ischemia" interpretation does nothing to confirm or deny any of the potential differential diagnoses. Sounds like the patient eventually consented to transport and an ED evaluation, so hopefully they figured out what was going on.
 
You experienced a very standard syncope call.

Like textbook syncope call...

Welcome to EMS. We do this same thing all day long.

Don't worry about the monitor, you worry about your assessment skills and your base knowledge. The cool toys come later
 
GoldcrossEMTbasic said:
The off duty cardiologist told the patient that there is a potential heart issue going on. And he told her that she needed to have further testing done. So to clarify something, if the monitor shows Anterior Ischemia is it a false reading or a confirmed reading? I know what a AI is. It is a lack of o2 to the front part of the heart, due to a blockage possibly atherosclerosis.
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It's the kind of odd remark a computer would say.

Ischemia in the heart is usually described along an axis from "ischemia" (not enough oxygen, but it's not causing any damage) to "injury" (cells are damaged) to "infarction" (cells are dead). If you or I run some sprints we might get coronary ischemia. The sort of MI you learned about in school involves injury, and we try to catch it before it becomes infarction.

While "anterior ischemia" is as you describe, it's not an emergency. In fact, while some folks think you can use the ECG to localize ischemia to a specific region (like the anterior wall), you really can't, not like you can injury/infarction. Hence -> weird computer remark.

None of this means that somebody who suddenly passed out shouldn't get worked up further.
 
I agree, because all VS were within normal limits her only chief complaint was she was lightheaded and dizzy and then went to the floor. And then a few seconds later she was alert. And taking her pulse the off duty doc said, I had no pulse for a few seconds. But the PT is an obese PT. But she was breathing and respirations were 18 and her o2 sats were 85 and PT states that is normal for her since she has a HX of COPD and on a NC @ on 2 LPM on home oxygen. I think that she just had a plain syncopal episode. Like I've said, everything was unremarkable and her skin, color and condition was WNL x3.
 
Yes, agree, and the only person to make that determination is the ER doc or the medical director, they are the ones who makes the call and tells us out in the field what to do. We attempt to treat the patients and get them to the ER STAT, and it is in the DOC's hands. EMT-B's or EMT-P's really cannot diagnose. We assess and follow orders and follow with the treatment protocols.
 
Also, out of genuine curiosity, what do you mean by "all measures for a possible cardiac arrest were implemented"? Cardiac arrests should either exist or not exist without any "possible" modifier when medically trained personnel (notably a cardiologist) have evaluated the patient. Did someone attempt compressions, AED application or BVM ventilations? It doesn't sound like it, so I wouldn't say anything about possible cardiac arrest.

In many cases of syncope, temporary hypotension can cause a decrease in cerebral blood flow leading to loss of consciousness and a transiently difficult to palpate carotid pulse. Just because a pulse was hard to palpate for a few moments doesn't mean the patient arrested, though we can't rule anything out.

Like Robb said, this is a pretty darn basic and straightforward syncope call from what it sounds like. As you get more involved in EMS you'll see them all the time.
 
Let' me clarify that, What happened was the a bystander ran and got the AED another bystander called 911. And then we checked for responsiveness and the PT was responsive and came too. What I meant by cardiac measures, was the bystanders did what was supposed to be done in case of a cardiac arrest. AED and EMS activated. I hope that clarifies what I have stated.
 
GoldcrossEMTbasic said:
Yes, agree, and the only person to make that determination is the ER doc or the medical director, they are the ones who makes the call and tells us out in the field what to do. We attempt to treat the patients and get them to the ER STAT, and it is in the DOC's hands. EMT-B's or EMT-P's really cannot diagnose. We assess and follow orders and follow with the treatment protocols.
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Some of this is so patently false! No doctor "makes the call" out in the field for our patients. They certainly write the protocols, give us authority to practice and give guidance when necessary, but they certainly don't make the day to day treatment decisions in our line of work.

We attempt to treat the patients as is best for them, and we don't always need to get them to the hospital "STAT" or even at all. We wake up diabetics all the time who we gently treat, and if there is a known cause for the hypoglycemia (often took insulin and failed to eat) feed them a sandwich and send them on their way.

Also, we absolutely diagnose. I'll add more to this later if I'm feeling ambitious and less cranky.
 
GoldcrossEMTbasic said:
Yes, agree, and the only person to make that determination is the ER doc or the medical director, they are the ones who makes the call and tells us out in the field what to do. We attempt to treat the patients and get them to the ER STAT, and it is in the DOC's hands. EMT-B's or EMT-P's really cannot diagnose. We assess and follow orders and follow with the treatment protocols.
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You have been misinformed. We absolutely diagnose. Diagnose simply means that you take the information you have available ( history, assessment, scene, etc ) and make a determination of what you think is going on. If we didn't diagnose you wouldn't know how to treat or what guideline / protocol to follow. We also operate under our own license with medical oversite.... This is different from working under a doctors license.
I you mess up it is on you not the doc.
Speed does not = good or quality care. Lights and sirens saves very little time and we see very few time sensitive injuries/illnesses.

The higher you get the more you need to think and develop treatment plans. I am not saying don't follow protocols but realize what they are. They are not a list that has to be followed a-z every time no exception. It is not a cookbook. Not all pts fit into a protocol. Some have more leeway than others but know that following protocols blindly can harm pts .
 
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You guys are liars.

I do the same thing as the trauma team but with two people, an 1/8th of the space and going 90 miles per hour.

/being an ***.

OP while this call sounds relatively unremarkable sync opal episodes can have very deadly etiologies and need to get a thorough assessment. I'm not a huge fan of amazing syncope a unless I can truly peg down the cause with confidence.
 
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GoldcrossEMTbasic said:
What'cha talkin about Robb?
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Sorry I was mocking MedicTim and talking about diagnosing. :)

EMS does diagnose, how do we decide what we're going to do for the patient without a differential diagnosis?
 
Robb said:
I can't wait until people actually know what we're talking about when they get called an LIV lol
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It was a shameful moment for me when I had to ask to find that one out...
 
chaz90 said:
Some of this is so patently false! No doctor "makes the call" out in the field for our patients.
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Well, in many areas, an on-scene physician can assume care, but usually with the stipulation that they provide identification, take full responsibility, and accompany the patient all the way to the ED. I think places vary on whether the EMS crew is "required" to follow the orders of the scene doc if they're willing to do all that, but it doesn't come up much.
 
Brandon O said:
Well, in many areas, an on-scene physician can assume care, but usually with the stipulation that they provide identification, take full responsibility, and accompany the patient all the way to the ED. I think places vary on whether the EMS crew is "required" to follow the orders of the scene doc if they're willing to do all that, but it doesn't come up much.
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I meant more day to day on the vast majority of our calls. Yeah, if one of our ED docs or medical directors showed up and wanted to run a call, you'd better believe I'd step out of the way. Like you said, just doesn't happen often.
 
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