Cardiac monitoring

[usalsfyre]

Honestly, with a 5min ETA why **** around ne longer then you really have to? Just load and go. Load and go will be the most important intervention you will give either of these patients in the absence of life-threatening, need corrected right now problems.

I had an MVC patient the other day that was literally 2mins from the hospital on the same street. He had a cardiac hx and was having anxiety and chest discomfort suspected to be from seatbelt. He got a cardiac monitor and 12-lead and right as the 12-lead was done we were backing in. I wasn't gonna spend extra time onscene asking 20 million questions, starting an IV, etc. when I could have this patient in the ED where he really needed to be.

Point being... regardless of ETA it takes very little time to throw electrodes on. But at the same time with a young patient, no PMH, and <5min ETA, the monitor really isnt a big deal in my opinion.

And if the radial pulse check correlates with the rate display on the pulse ox and patient is perfusing well, then I would trust the pulse ox in a stable patient for the short amount of time as described.

Everyone has their own thought and decision making process. The common thing to do is O2, IV, monitor, vitals... hmmm... really? We all know what the research says about everyone getting O2 so we can take that out. Does everyone really need an IV? Really? The same can be said about the monitor. Yes, its good to have it on for trauma patients to monitor rate and for ectopy but I certainly would not hammer someone for not applying it if they were busy doing an assessment or tending to actual patient injuries with a less than 5min ETA.

5 minutes to a Level 1 center with cardiac capabilities is one thing. 5 minutes to a community ED that is not able to handle an emergent patient is another. In this case it makes a lot more sense to spend a few extra minutes on scene to ensure you make the correct transport decision than doom the patient to an hour plus hour wait and possible death in the wrong ED

 

[MasterIntubator]

And would you monitor either of these patients?

Yes. #1 is stable, I would have time to complete a good assessment and get ahead of the ball ( if needed )

#2 - based on presenting info, is also stable, so I would have time to complete a good assessment. Being whacked at 25mph can be quite significant, and with the syncope... gonna look at that closer.

 

[cruiseforever]

I wanted to get some feedback on how many folks decide to for go cardiac monitoring. In the following two scenarios you are less than 5 minutes from the ER.

This is limited to these two specific scenarios only.

You have a ped vs car less than 5mph. AAOx3, pulse is regular, strong.

You have a bicycle vs car 25mph. Initially unresponsive, then minutes after is responsive and AAOx3. Pulse is regular, strong.

In both cases you decide to simply monitor the heart rate with pulse oximetry and occasional pulse checks at wrist.

I know it doesn't take long to put them on, but when you don't have much time and other things need accomplishing and are more important, it doesn't make since for me to put them on.

If any of the above scenarios resulted in difficulty finding pulses, patient not alert or irregular heart rate noticed on palpation, cardiac monitoring would be applied

Any feedback?

With a short transport time. I make sure the ER is notified first and then do what I can get done. Monitor is pretty low on my list with a good pulse and AxOx3.

 

[Mex EMT-I]

I just love to read this posts because here in my town we don´t even have ALS ambulances. 1 in 10 ambulances has a cardiac monitor.

With that said.

None of this patients need cardiac monitoring. The ETA is absurd. The correct thing to do is finish up with the BLS stuff, like a full assesment, set of vitals, focused exam, etc. And then if there is time think ALS.

 

[usalsfyre]

I just love to read this posts because here in my town we don´t even have ALS ambulances. 1 in 10 ambulances has a cardiac monitor.

With that said.

None of this patients need cardiac monitoring. The ETA is absurd. The correct thing to do is finish up with the BLS stuff, like a full assesment, set of vitals, focused exam, etc. And then if there is time think ALS.

I'm amazed by the number of people who want to scoop and run doing assessment enroute without knowing anything about the ED. That's fine if your hospital is an academic level I I guess. My local ED is a level IV with a small blood blank, surgery and anesthesia not immediately available, no cardiology or neuro services, and no provision to care for the the critically ill post-surgical patient. I've bypassed to a different facility when I was literally 30 seconds away for these reasons. My patients get a thorough assessment prior to transport (including "ALS"'stuff like cardiac monitors and EtCO2) so I can make the appropriate transport decision. Outside of securing an airway, everything else is done enroute.

Or do your systems not allow you to bypass and refer the patient to an appropriate facility? If this is the case I can maybe see the scoop and run plan. But practicing this way is EMS circa 1985...

 

[vquintessence]

... Or do your systems not allow you to bypass and refer the patient to an appropriate facility? If this is the case I can maybe see the scoop and run plan. But practicing this way is EMS circa 1985...

This is the case in MA, and making a reasonable assumption is similar w/ other states. BLS is allowed to deviate up to 10 minutes to a "further hospital" if pt meets a checklist stable criteria; ALS is allowed 20 minutes w/ similar criteria. Of course there are trauma & STEMI point of entry protocols that trump all.

The state even permits services to put into a charter (or by-law?) for "mandatory" hospital designations for EVERY pt. Many Fire Depts and 3rd Services implement these. I assume privates do not because it leaves more happy customers (and more mileage means more money)?

 

[Mobey]

I just love to read this posts because here in my
None of this patients need cardiac monitoring. The ETA is absurd.

You're right, they don't NEED cardiac monitoring.
Nor do they NEED vitals taken.
Really, they dont NEED an ambulance.

I do not make it a habit to only treat/assess people with what they NEED.
Otherwise my narc pouch would never open.... I mean really, no one dies from pain, so no one really NEEDS pain control.

 

[AndyK]

I usually just say that squeezy thing attached to the monitor. h34r:

Aye, that's the wotsit.. right next to the fingery thing and the machine that goes bleep

 

[Mex EMT-I]

I stand in my position.

The don´t need it.

When you have very limited resources one of the first things you learn is not to waste those resources just because you can do something.

I really like what TomB says about the traction splints.

 

[Mobey]

I stand in my position.

The don´t need it.

When you have very limited resources one of the first things you learn is not to waste those resources just because you can do something.

No where in this scenario did it say anything about limited resources. So again, your theory fails.

 

[usalsfyre]

I stand in my position.

The don´t need it.

When you have very limited resources one of the first things you learn is not to waste those resources just because you can do something.

I really like what TomB says about the traction splints.

I guess I've been lucky. I've worked in and around some pretty flat broke systems, but the cost of three electrodes for an assessment tool has never been a concern (it's not an intervention, the traction splint analogy doesn't apply).

I guarantee patient #2 will be on a cardiac monitor in the ED with a loss of consciousness.

 

[Mex EMT-I]

You are right nobody said that you had limited resources in that senario.

Still. They don´t need.