Modified Chest Leads

[kindofafireguy]

Really the best thing you can do for your pt is to treat them just like you treat any chest pain/cardiac pt. I understand the need for 12-lead to make a transport decision, but knowing if it's a true STEMI or not shouldn't change your treatment.

Actually, it can change your course of treatment. One example I can think of would be inferior STEMI, where you can dangerously drop preload through use of vasodilators (although you should always follow your protocol).

But to think that you should treat it the same as any other is dangerous. The old adage "No call is routine" comes to mind. When you start treating things the same, you run the risk of rote treatment and missing something critical.

Just my $0.02 though.

 

[Brandon O]

More to the point, perhaps, STEMI care epitomizes the concept that EMS's most important role is triage, transport to the appropriate destination, and mobilization of needed resources. It may or may not be terribly important whether you crack open the nitro or morphine, but if you say "it's not just chest pain, it's a STEMI," bring them to the right place promptly, and activate the cath lab fast, you may get them reperfused (thrombolysis or preferably angioplasty) hours earlier. And yes, that may save their life.

Exciting stuff? I dunno. Do you want to save lives?

 

[kindofafireguy]

More to the point, perhaps, STEMI care epitomizes the concept that EMS's most important role is triage, transport to the appropriate destination, and mobilization of needed resources. It may or may not be terribly important whether you crack open the nitro or morphine, but if you say "it's not just chest pain, it's a STEMI," bring them to the right place promptly, and activate the cath lab fast, you may get them reperfused (thrombolysis or preferably angioplasty) hours earlier. And yes, that may save their life.

Exciting stuff? I dunno. Do you want to save lives?

Actually, it's the whole premise of EMS. EMS revolves ultimately around transport of the patient to the appropriate definitive care, with appropriate being the key word.

My point was simply that the 12-lead itself could change your treatment plan, but that was more of a specific point than a general concept.

I'm agreeing with you Oto, by the way. For some strange reason my post sounds wrong when I reread it. I hate the interwebz.

 

[Brandon O]

Actually, it's the whole premise of EMS. EMS revolves ultimately around transport of the patient to the appropriate definitive care, with appropriate being the key word.

My point was simply that the 12-lead itself could change your treatment plan, but that was more of a specific point than a general concept.

Agreed all around. And it does sometimes seem like you have to demonstrate to medics how certain elements of the 12-lead can directly affect their interventions before they appreciate their importance. (Me, I think that transport IS an intervention, but not everybody is impressed by that idea...)

 

[kindofafireguy]

I like to point out to people that ultimately, the basics of EMS are the most critical parts of the system.

Patient assessment and triage, followed by timely and proper transport are ultimately what save patients. Doctors save patients, EMS just makes sure they get to the right ones (in theory).

We are the band-aid on life's ills, not the saviors.

 

[KellyBracket]

... Doctors save patients, EMS just makes sure they get to the right ones (in theory).

We are the band-aid on life's ills, not the saviors.

We're all band-aids, and that's only if we're good at what we do. EMT-B, ED doc, ICU doc - we're all working to "cure sometimes, to relieve often, to comfort always."

 

[abckidsmom]

We're all band-aids, and that's only if we're good at what we do. EMT-B, ED doc, ICU doc - we're all working to "cure sometimes, to relieve often, to comfort always."

Quoted for truth.

 

[TheLocalMedic]

Update

All right, so I totally just ran into the guy that was my patient in this post. Turns out he's a groundskeeper at one of the local retirement communities. I asked about what happened after he was flown out, and he said he "was really having a heart attack" and says that he had a stent placed that same day. He also says he feels great now, even though he if being forced to eat healthier.

So it sounds like he definitely benefited from being flown.

 

[emtdansby]

Everyone has made many good points to my previous comment. It's very true, knowing where the STEMI is located can change the course of treatment. Perhaps my statement was too simple. What I was trying to say, with the OP's current situation, all he can really do is treat "suspected" STEMI's (ie chest pain with tale tell S/Sx) with appropriate chest pain protocol. He has no way to know for certain if it's truly a STEMI, hence the "suspected". As for the transport decision, with his current situation, transporting to the closet facility would be most appropriate, there they can obtain a 12-lead and start other treatments that would be needed. Once again, I will suggest he speak to his medical director about his concerns with the lack of 12-lead capabilities in the field.