Serial 12 Lead EKG in prehospital setting (How many of you do it?)

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Ecgg

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Just curious how many here actually keep the 12 lead electrodes connected for the duration of transport and conduct serial 12 leads?

Before once I saw a STEMI the precordial leads came off and just monitor remained, usually would get the pads ready and plan for ACLS.

Now I keep all the leads on and usually do another if patient conduction changes, any complaints, response to meds. If all I saw was TWI or depressions and no ST elevations, I do one before wheeling through the doors so I don't get these idiot drivers look from the staff holding hospital EKG showing 2mm elevations.

A study on this http://www.ncbi.nlm.nih.gov/pubmed/21954895
 
We have a typical transport time of 1 hr. I leave the leads on and get another 12 lead whenever there is a change.

I had a guy with a STEMI last week that was about 2-3 mm elevation in v1-v4 that was completely resolved on ED arrival because of my treatment. He still went to the cath lab and had his reperfusion there.

I do not want to be surprised by what the ED admission EKG looks like. Ever. If the 12 lead is a big part of what we have going, at a minimum I get one on scene and one just prior to arrival at the hospital.
 
I always did serial ekgs. Generally onscene, enroute (if long enough tx time), and at destination.
 
45min to 3 HR transport time yes I do them

But when I had short transport times I always tried to do them due to the fact that sometimes what we do changes what the 12 lead shows.
Pre O2, Pre NTG, pre Pain relief I have also had multiple patients with Severe STEMI's showing normal when I got to the ED due to treatment.

If I didn't have a early 12 lead it can delay their time to the cath lab. Also I leave the leads on, and anytime the patient states that the pain has increased or changed then I can hit the button and see what changes it shows, surprising what you may find
 
I do them quite frequently. In particular, I make sure I do a couple when the presentation really makes me think MI and I'm just not seeing EKG changes yet. I've seen a series of 12 leads over a 20 minute transport that went from pain but no ST changes to full blown inferior STEMI.
 
Do them here. Well I do not sure about other medics.

One gets done after every medication that may cause changes or a change in pt complaint (Ntg, ms, metoprolol if applicable). We have short transport times (<20 minutes usually) but I still do them. Give a spray, do something else, in a couple minutes hit the "acquire new 12-lead" button after instructing the pt to hold still for a minute and walla. Generally will try to get them when we are moving slow or stopped but not always possible.

We have the Philips MRx so I leave it in the live 12-lead view on all cardiac patients.

Every printout gets labeled, (pre ntg, post ntg 1, post ntg 2, ect...)

Any inferior gets a right sided view as well.
 
I do it. Usually at least three. One at contact, at least one while en route, and one as I arrive at the ED. They're free...and take no time.

One is interesting. Two provides a contrast. Three gives you trending.

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In the words of Dr. Corey Slovis: "One ECG begets another"
 
DEmedic said:
One is interesting. Two provides a contrast. Three gives you trending.
Click to expand...

I like that, trending is where it's at. If we are prudent trending get's done for all other diagnostic tests yet 12 Lead seems to be that 1 hit wonder.
 
If an active CP: one before NTG, one after NTG, one if pt. becomes pain free, and one at arrival. More 12 leads if there seem to be changes evolving.

Everyone else would vary.
 
Ecgg said:
I like that, trending is where it's at. If we are prudent trending get's done for all other diagnostic tests yet 12 Lead seems to be that 1 hit wonder.
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Agreed, I've had coworkers here look at me like I have three heads when I come in with an active STEMI and 3-4 12-leads. My question is why not do them? They're painless, non-invasive and are dynamic. That reason at the end right there makes me wonder why serial 12s aren't the standard.

People in this thread have said it, elevation can resolve with ACS treatment. I'd be interested to see if anyone had ever had an ER cancel a STEMI protocol due to a 12-lead that's "within normal limits" upon arrival to the ED with a patient that's pain free only to have to re-activate later when the elevation returns? I think that would be retry shotty on the hospital's part but stranger things have happened. Whereas if you do serial 12s and show the resolution of the elevation throughout us treatment you can make a much strongest case rather than just "I swear I saw elevation!"
 
Continuous *should* be the norm.
 
DEmedic said:
In the words of Dr. Corey Slovis: "One ECG begets another"
Click to expand...

Haha I was literally saying this in my head as I read this thread title. Did you hear this from a recent episode from Dr. Amal Mattu?
 
No, I went to a presentation on STEMI care that he gave. He's a great speaker. Entertaining and informative.
 
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DEmedic said:
No, I went to a presentation in STEMI care that he gave. He's a great speaker. Entertaining and informative.
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Ah gotcha, Amal Mattu was quoting him and showed his picture in one of his videos not too long ago.
 
Robb said:
...
I'd be interested to see if anyone had ever had an ER cancel a STEMI protocol due to a 12-lead that's "within normal limits" upon arrival to the ED with a patient that's pain free only to have to re-activate later when the elevation returns? ...
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Yeah, that ER doc was me - once. Not doing that again!

Spontaneous reperfusion of a STEMI is a good sign, but it hardly means the patient is out of the woods. And despite the impression that NTG or ASA caused the ECG change, the evidence isn't clear what the mechanism is. Nonetheless, it's a very good idea to get multiple ECGs, just like our northern friends have demonstrated!

Edit: Re-read the quote. I actually didn't cancel anything EMS had activated, in my defense, since the ECG resolved in the field. If EMS called again with this situation, I would green-light the lab, mos def.
 
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KellyBracket said:
Yeah, that ER doc was me - once. Not doing that again!

Spontaneous reperfusion of a STEMI is a good sign, but it hardly means the patient is out of the woods. And despite the impression that NTG or ASA caused the ECG change, the evidence isn't clear what the mechanism is. Nonetheless, it's a very good idea to get multiple ECGs, just like our northern friends have demonstrated!

Edit: Re-read the quote. I actually didn't cancel anything EMS had activated, in my defense, since the ECG resolved in the field. If EMS called again with this situation, I would green-light the lab, mos def.
Click to expand...



I serial 12-lead....everyone I 12-Lead, actually.
 
KellyBracket said:
Yeah, that ER doc was me - once. Not doing that again!

Spontaneous reperfusion of a STEMI is a good sign, but it hardly means the patient is out of the woods. And despite the impression that NTG or ASA caused the ECG change, the evidence isn't clear what the mechanism is. Nonetheless, it's a very good idea to get multiple ECGs, just like our northern friends have demonstrated!

Edit: Re-read the quote. I actually didn't cancel anything EMS had activated, in my defense, since the ECG resolved in the field. If EMS called again with this situation, I would green-light the lab, mos def.
Click to expand...

Your secret is safe with me haha.

I've never seen elevation resolve but I've heard of crews getting crap because their patient's elevation did and they didn't have serial 12s to prove it.
 
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