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

Sublime said:
Link to specific episode
http://ekgumem.tumblr.com/post/49173607390/corey-slovis-meets-rodney-dangerfield-10-minutes

Link to home page. Definitely the best thing I've discovered in regards to advancing my EKG knowledge.
http://ekgumem.tumblr.com/
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Thanks, that looks promising.

I have one of his books ECG's for the Emergency Physician 1 by Mattu, Amal and Brady, William J. (Sep 29, 2003)

Has some good 12 lead examples with breakdowns.

The video cases are much better just from a couple that I watched thus far.
 
This is slightly off topic, but in case anyone is looking for a good read this book has all the authors mentioned in this thread and covers very pertinent topics related to prehospital care.

Avoiding Common Prehospital Errors [Paperback]
Benjamin J. Lawner DO EMT-P (Author), Corey M. Slovis (Author), Raymond Fowler MD FACEP (Author), Paul Pepe MD MPH MACP FCCM FACE (Author), Amal Mattu (Author)
 
Ecgg said:
This is slightly off topic, but in case anyone is looking for a good read this book has all the authors mentioned in this thread and covers very pertinent topics related to prehospital care.

Avoiding Common Prehospital Errors [Paperback]
Benjamin J. Lawner DO EMT-P (Author), Corey M. Slovis (Author), Raymond Fowler MD FACEP (Author), Paul Pepe MD MPH MACP FCCM FACE (Author), Amal Mattu (Author)
Click to expand...

Will check it out thanks
 
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.
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My secret is not showing the ED the resolution ECG...is that wrong?

I obtain serial ECG's on anybody who gets a 12-lead. Typical intervals are q5 minutes when I was on the LP12, but now with the Zoll X-Series I just leave the 12L screen up and print when it looks different.

As this study out of Toronto showed, a single ECG is only going to catch 84% of STEMI patients:

STEMI was identified on the first prehospital ECG in 275 cases, on the second ECG in 30 cases, and on the third ECG in 20 cases (cumulative percentages of 84.6%, 93.8%, and 100%, respectively). For STEMIs identified on the second or third ECG, 90% were identified within 25 minutes after the first ECG.
 
I always do a minimum of 3. Initial, 2nd w/ V4r/V8/V9, and one at the hospital. If treating active chest pain (without ST or T wave changes) I do the inital, 2nd with right and posterior leads, after nitro series, and 1 at hospital. If treating active STEMI I do: initial, 2nd with right and posterior leads, then I set the LP12 NIBP to q5 and reacquire a 12 lead q5 when it takes a BP while treating with NTG/ASA/Plavix/Heparin/Metoprolol, and at the hospital. I also label serial 12 leads with prior treatment and pain level.

We have anywhere from a 15 min to 60+ minute transport time.
 
SHAZAM!

Wish I had the 12 lead to show off, but here's what I had a few weeks ago!

54 YOM c/o chest pn. No history, no risk factors, overall seemed pretty fit. First 12 lead was negative, beautiful sinus rhythm. Gave aspirin and nitro, loaded up and began transporting.

Popped an IV in, chest pn was no longer present so I held off the nitro, and took another 12 lead. Again, beautiful sinus rhythm.

And then the chest pain came back...

Third 12 lead didn't print out automatically like it should have, but when I took it it read: ***MEETS ST ELEVATION MI CRITERIA*** and showed significant elevation in II, III and aVF.

Repeated it just to be sure and it showed the same thing. Code 3 diversion to the STEMI center.

Guy had a 100% occlusion!!! So leave those leads on and crank out serial 12 leads if it's looking like a possible cardiac event!
 
Yes. First contact, after each treatment, and on arrival of destination
 
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