Chest pain

[Melclin]

We don't have a written protocol about it but the thought of QA/QI is "if you were suspicious enough to use the monitor you need to ride in with the patient."

Not saying it is or isn't right, that's just how it is here. Every ambulance is ALS so it's not taking two resources out of service to transport that patient with an ALS provider attending.

I suppose there is a certain amount of logic to that.

We tend to put the monitor on as a matter of being thorough, but how much a rhythm strip can really change you decision in and of itself as far as leaving people at home goes is probably questionable over all.

Certainly though, we've all had patients around here in whom we chucked the monitor on in the interests of being thorough for that pt we thought was a sook and low and behold, a block/arrythmia/something else was evident.

I've heard plenty of anecdotal evidence of people in stable VT with reasonably atypical symptoms being discovered only by ECG.

I personally had a patient I thought was mildly depressed until I discovered discovered him to be in an Af of 200, despite his palpated irregular pulse of 72 consistent with his hx of chronic Af.

Ah now I'm rambling. Melclin out.

 

[usalsfyre]

At the risk of sounding BLS. Treat your patient , Not your monoitor.

If I'm going to discard what the monitor is telling me...why am I hauling around 30 extra pounds of kit?

 

[Handsome Robb]

I suppose there is a certain amount of logic to that.

We tend to put the monitor on as a matter of being thorough, but how much a rhythm strip can really change you decision in and of itself as far as leaving people at home goes is probably questionable over all.

Certainly though, we've all had patients around here in whom we chucked the monitor on in the interests of being thorough for that pt we thought was a sook and low and behold, a block/arrythmia/something else was evident.

I've heard plenty of anecdotal evidence of people in stable VT with reasonably atypical symptoms being discovered only by ECG.

I personally had a patient I thought was mildly depressed until I discovered discovered him to be in an Af of 200, despite his palpated irregular pulse of 72 consistent with his hx of chronic Af.

Ah now I'm rambling. Melclin out.

I agree with everything you're saying here. I don't understand why we can't do a 4-lead on ILS patients then remove it or even allow the Intermediate to attend the patient on the way in with the 4-lead still in place for the sake of being thorough and possibly discovering an underlying condition that may warrant further assessment in the prehospital field. I like to think of myself as a thorough medic and tend to put people on the monitor more than many others.

I too have had a few interesting experiences with patients presenting with benign, atypical symptoms in the presence of arrythmias, particularly pulsatile VT.

Had a guy when I was even newer than I am now who was ambulating around sucking on some copenhagen, joking with the FD, in no obvious distress, pink warm and dry and walked to the ambulance climbed on in. His only complaint was "a lump in my throat", nothing else whatsoever. He ended up being in VT at ~190 and like your AF patient, his palpable pulse was much lower than 190. Only reason he went on the monitor was when I asked if he'd ever felt this sensation before he started "they put me to sleep and barbecued me with those paddle thingys".

If I'm going to discard what the monitor is telling me...why am I hauling around 30 extra pounds of kit?

Yea...you covered that already.

In the famous words of one of my many mentors: clinical correlation! Use the quantitative/qualitative assessment tools along with clinical presentation to make an informed clinical decision. Not one or the other.

 

[EMT B]

Was SSRI withdrawal or discontinuation considered?

is this still a consideration even though the patient was never on an SSRI?