What would you do in this situation?

Gurby

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I wouldn't call a STEMI by way of a 2 lead reading. Almost guarantee it is one, but you really should have a 12 lead.

Actually II and III are continuous leads right? I guess technically you shouldn't need the other leads - with a good chest pain story you can probably still call it. We still want the 12 lead, but I don't know that it's strictly necessary for the purposes of calling this a STEMI.

...Well, I guess we need to see reciprocal changes as well. So yeah, more leads.
 

teedubbyaw

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Actually II and III are continuous leads right? I guess technically you shouldn't need the other leads - with a good chest pain story you can probably still call it. We still want the 12 lead, but I don't know that it's strictly necessary for the purposes of calling this a STEMI.

...Well, I guess we need to see reciprocal changes as well. So yeah, more leads.

They are contiguous. Lead II is non-diagnostic by itself for ST elevation. Adding lead III doesn't mean much.

That is a very specific injury pattern, and I don't doubt the 12 lead would confirm a STEMI.
 

OnceAnEMT

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I wouldn't call a STEMI by way of a 2 lead reading. Almost guarantee it is one, but you really should have a 12 lead.

I completely agree, which is why I would love to have that ALS intercept. But patient life > my reputation. Its a what if. Didn't even know getting just a 2 lead was still a thing...
 

STXmedic

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An exceptionally regular rhythm with a rate of roughly 90, no P waves, possibly wide QRS, and only a filtered 3-lead view? Am I the only one that thinks that looks an awful lot like a paced rhythm?...
 
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jdox0776

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Its a STEMI. I need 2 leads of greater than > 1 mm ST Elevation, and that looks like it would fit the bill. To ask again, is it an ALS or BLS response? If its BLS getting the 2 lead, then we know we need to get to a PCI center now. This will soon be a time dependent emergency (if you don't consider it one already), and ALS won't save this guy. If you can get an intercept now or en route with little to no delay, then hell yes, get a solid 12 lead and make sure. If it was originally an ALS response, I would've hoped for a 12 lead to start. But now its certainly needed.

Diminished lung sounds are interesting. But my guess here is that the breathing is so labored and shallow that it isn't worth much of a listen. If I can't get even a 5 lead now or very soon, be it mine or ALS, I'm code 3 to a PCI center (if it would make a difference in the area, naturally). Consider down grade if improvement is shown en route.
ALS, that rhythm was 4 minutes before respiratory arrest followed by cardiac arrest.
 

jrm818

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Actually II and III are continuous leads right? I guess technically you shouldn't need the other leads - with a good chest pain story you can probably still call it. We still want the 12 lead, but I don't know that it's strictly necessary for the purposes of calling this a STEMI.

...Well, I guess we need to see reciprocal changes as well. So yeah, more leads.

The presention of this scenario is very strange and I doubt anyone is getting a realistic picture of how events unfolded.

That said, a reminder
You need not just more leads, but also different mode. There is much unsupported dogma in ems, but "you can't diagnose a stemi in monitor mode" is actually true
 

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STXmedic

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The presention of this scenario is very strange and I doubt anyone is getting a realistic picture of how events unfolded.

That said, a reminder
You need not just more leads, but also different mode. There is much unsupported dogma in ems, but "you can't diagnose a stemi in monitor mode" is actually true
I wish I could like this more than once.
 
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jdox0776

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ERDoc was right I was on another site before I had all the evidence and facts. I have proof now. As I stated on the other site just because you are a "layperson" doesn't mean that you are "acting out of grief to point the finger to blame someone else". When this happened I was wanting to go back to school but wasnt sure what I wanted to do. I decided to go to EMS school. I am not asking for legal advice because I already know I have a case and I do have a lawyer. I know no one wants to admit that EMS does in fact make mistakes, it does happen. What bothers me is those mistakes may have contributed to his demise. I know what they did and didnt do (some of which is hearsay).

My brother had a reputation with the local hospital, he was known to have very poor hygiene and to be VERY needy. EMS had been called out on several different occasions. These particular EMS were approaching the end of their 24 shift. He presented with these symptoms. They were at my house for WAY too long as he should have been load and go. I knew they didnt an ECG initially as the PCR stated and recently I got the ECG report from ambulance service thats. The first one never existed. The second one I posted was labeled as NSR. It was not, I already had it interpreted. They did not do an ECG, attempt IV access until 30 min later, no cap wave. Minutes before he arrested he had what I initially thought was a seizure but realized it looked different. He postured. There are errors all over PCR. A lot of things were not documented, ALL the symptoms, no description, onset, duration of said seizure, the three failed IV attempts, chief was listed as cardiac arrest and it should have been that he couldnt breathe. He was having trouble speaking full sentences and I told them he couldnt breathe. Chief complaint should be the presenting symptom said by the patient or family member not the end result.

They panicked when this all went down, whoever reported the information to the ER was rattled. According to PCR they arrived at ER at one time and ER records say a later time. I knew they were there longer than the PCR stated. They couldnt even intubate because his trachea had deviated left. They certanly couldnt gain IV access with his extremities clamped down. So no initial ECG, no Oxygen, no IV, no cap wave, no cardiac monitor. They did the 2 lead because they didnt have time for a 12 lead. His symptoms were not taken seriously, I get they didnt realize how serious it was but thats why you have protocols for what should be done for resp distress, none of which was done at first. Funny thing is the previous call that wasnt life threatening the first two things they did was gain IV access and cardiac monitor, they were out of my house within 10 minutes. They plain and simple didnt want to touch, I admit he smelled but EMS comes in contact with many different fluids, he smelled particularly bad with his diaphoresis. They wanted him to physically get up and walk to the stair chair but he wasnt physically able to . It took 30 minutes before they finally did when I yelled at them to help him, my brother had been helplessly flopping around trying to do what they asked him to do. His limbs simply would not allow it, his body was out of his control, he couldnt walk.

It bothers me that the PCR clearly shows an attempt to cover it up, I guess they hoped my aunt and I wouldnt dig further. I have mad respect for EMS, its not an easy job but it requires empathy, respect, urgency, complete dedication to the patient even if they are difficult and you would really rather to pass this one up. I have been there when I was MA, some patients make you *dread* but you still have to put your smile and do your job. I have nothing against any of you I am just trying to understand why all this happened, wrong time, wrong place. They should have observed the danger instead of assuming it wasnt. No one followed protocol for prehospital assessment. Its funny for so long I didnt know what I wanted to with my life. Out of this tradgedy it became clear. I had wanted to be a EMT ever since I was a kid and I would really like to stay here and be part of your community. It is important for all EMS to stay on their toes planning to expect the unexpected in every single call.
 
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jdox0776

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An exceptionally regular rhythm with a rate of roughly 90, no P waves, possibly wide QRS, and only a filtered 3-lead view? Am I the only one that thinks that looks an awful lot like a paced rhythm?...
This was the rhythm he had 4 min before arrest. They did somehow manage to get a brady rate with ectopy after four round with Lucas, epi and a bi carb, they tried pacing but was unsuccessful. He had not been shocked at this point but as you can see from the top of the strip they had just powered it on. He should have been on the cardiac monitor from the get go. I do have the other strips where he alarmed and the pacing attempts that followed. Im not sure at this point if I will get flamed off the board for this. I apologize. I am not seeking legal advice I just really needed to vent to you guys.
 

teedubbyaw

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So what makes you a medical expert specializing in the field of EMS? Are you an equally trained paramedic? If not, how do you know what should have been done vs not? How do you know they didn't follow protocols? Sorry for your loss, but just make sure your accusations are factual. I know it's easy to want to put the blame on someone, and if it's warranted, then so be it, but don't do it out of grief.
 

Handsome Robb

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So what makes you a medical expert specializing in the field of EMS? Are you an equally trained paramedic? If not, how do you know what should have been done vs not? How do you know they didn't follow protocols? Sorry for your loss, but just make sure your accusations are factual. I know it's easy to want to put the blame on someone, and if it's warranted, then so be it, but don't do it out of grief.

Agreed.

The way you describe symptoms may have presented very differently than what was observed by EMS. There's plenty of times the family is freaking out about something when there's truly nothing to freak out about. From your description I would've done a 12-lead at bedside, waveform capnography maybe but not necessarily. Still probably would've spent about as much time on scene as them.

Why was your brother out of his medications? Non-compliance with medications can't be blamed on EMS.

With that said I'm very sorry for your loss.
 

Gurby

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You need not just more leads, but also different mode. There is much unsupported dogma in ems, but "you can't diagnose a stemi in monitor mode" is actually true

You're right - I forgot! I know I learned that at some point... I would want a 12-lead anyways if I saw that on a monitor and was going to call a STEMI alert over the radio.
 

Ewok Jerky

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Sorry you lost your brother at such a young age.

We are monday morning quarter backing with second hand information over the internet.

It is absolutely not fair to apply our "what would you dos" to the EMS on scene.
 
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jdox0776

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So what makes you a medical expert specializing in the field of EMS? Are you an equally trained paramedic? If not, how do you know what should have been done vs not? How do you know they didn't follow protocols? Sorry for your loss, but just make sure your accusations are factual. I know it's easy to want to put the blame on someone, and if it's warranted, then so be it, but don't do it out of grief.
apparently you didnt read the entire message. I looked up the prehospital protocols for my state which applies to the entire state. No, am not a fully trained EMT yet (not until finish school) My aunt was a cardiac care nurse (CCU) for over 25 years and before that she was a paramedic. Point is they were there for 30 minutes before he went completely south. Why wasnt an ecg done? PCR says they did one but it doesnt exist (per the records lady at the ambulance service) and the one they did finally do was reported as NSR normal sinus rhythm on PCR when it actually was not normal. I got the official interpretation for it a couple days ago. It was one of those "you just had to be there" to see how bad he looked.
 
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jdox0776

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Agreed.

The way you describe symptoms may have presented very differently than what was observed by EMS. There's plenty of times the family is freaking out about something when there's truly nothing to freak out about. From your description I would've done a 12-lead at bedside, waveform capnography maybe but not necessarily. Still probably would've spent about as much time on scene as them.

Why was your brother out of his medications? Non-compliance with medications can't be blamed on EMS.

With that said I'm very sorry for your loss.
ECG would have been the most important thing they could have done, I had been taking care of him since our father died. We were trying to get him on SSI. He didnt always remember to take his meds and sometimes we didnt have the money for them (he didnt have insurance or medicaid and they were costly) He did have his meds on the night in question, he had been out of them prior though, he didnt always eat right either.
 

Ewok Jerky

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I am sure this was a terrable situation for you do deal with, but if you looking for validation, or for us to blame this all on the responding medics, you might be out of luck.

No offense but it sounds like a train wreck waiting to happen.
 
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jdox0776

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I am wondering why two fully trained paramedics would skip over protocol and then try to cover it up. Does anyone not take responsibility for their actions. If a mistake is made own it. Regardless if they were approaching 24 hours on the clock. Certain symptoms warrant certain tests like an ecg, forget about he capo, the ecg would have told them all they needed to know and how to proceed.
 

Ewok Jerky

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I am wondering why two fully trained paramedics would skip over protocol and then try to cover it up.

I don't know why two fully trained paramedics would skip over protocol and then try to cover it up. That doesn't make sense.

You should address your concerns to the parties involved not an anonymous internet forum that doesn't have all the facts.

Sorry but that's just how it is. You aren't going to get the answer your looking for here. And it sounds like you are lashing out which will put most EMS (or me at least) on the defensive.
 

luke_31

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I am wondering why two fully trained paramedics would skip over protocol and then try to cover it up. Does anyone not take responsibility for their actions. If a mistake is made own it. Regardless if they were approaching 24 hours on the clock. Certain symptoms warrant certain tests like an ecg, forget about he capo, the ecg would have told them all they needed to know and how to proceed.
Statewide protocols aren't what most services use. They are just that a statewide guidance for what is allowed by the state to be done. Each county and company can have different protocols based on what their medical director allows. Also whatever we say here is ultimately not relavent as in the court system the paramedics would be held to the standard of other paramedics within the system they are in. Different systems have different ways of doing things and it would be biased to take a paramedic in one system and hold them accountable if they don't perform like someone in another system who has different resources and possibly additional training required in their system that is not provided by the other system.
 
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