Atypical STEMT Treatment

[JwL]

Frank, I dont work in a rural area. We tx and transport hot MIs all year long so I'm afforded the opportunity to view real time 12 leads and even 15 leads when indicated. So, the senario presented with with a 12 lead indicating anterior lead elevation and I will even throw in reciprocal changes in leads 2,3,aVF with the pt being diphoretic and vomiting. All vitals are stable. The question was would one give NTG in the absence of CP knowing your pt is a diabetic woman?

 

[Frank frankerson ESQ]

Frank, I dont work in a rural area. We tx and transport hot MIs all year long so I'm afforded the opportunity to view real time 12 leads and even 15 leads when indicated. So, the senario presented with with a 12 lead indicating anterior lead elevation and I will even throw in reciprocal changes in leads 2,3,aVF with the pt being diphoretic and vomiting. All vitals are stable. The question was would one give NTG in the absence of CP knowing your pt is a diabetic woman?

You dont need reciprocal changes at all, you know that. If you’re 100% sure its a real MI and there are no contraindications its ok, but you must really think before you give NTG, and you are, which i respect. You have stable vitals, are you going 75 minutes on an IFT to a STEMI facility when youre not rural? The usual is you have a nitro drip, 2 docs, 10 residents, bilateral 14s, serial 12 leads, full hx, pads on, and instructions on what to do, before you even get to the patient. Might as well put a bow on it for you as well. When, in your urban “hot MI” IFT experience have you had to make the decision you are talking about? Diabetic woman out of the blue STEMI, during transport in URBAN IFT? It can happen, but like i said before its RARE. Youre already transporting a STEMI so i dont understand. Im addressing the issue that you seem to see it frequently. Lets talk about 911. A call with limited hx? Call medical control, send them the 12 lead. The monitor can print out ACUTE MI and it could look like one. Lead placement, artifact, early repol, BBB etc can make it look like, and make the monitor say, something that it isnt. Its not a simple decision in 911. If you stay current on 12 leads, think before you do something, and youre convinced its a STEMI, NTG will benefit the pt in your diabetic scenario. Be safe..