Worst Monitor Interpretation Ever.

[zmedic]

I'm not sure I agree with a 12 lead being the "first thing" I'd do with a symptomatic bradycardia. I'd probably put on a 4 lead and pacer pads and start treating. Then get a 12 lead when I get a chance. I know a 12 should take long but often, especially with an inexperienced partner they are untangling leads, dealing with sweaty skin for stickers etc.

You don't need a 12 lead for basic rhythm interpretation, a 3 lead will do as a first step.

 

[jroyster06]

My first thought on this wouldnt be a 12 lead. Ive always been taught treat rate then rythm. I would pace him. The only thing i think i would need a 12 lead for is to find out if it is an MI in which case Atropine would be contraindicated. The would have my pucker factor slightly elevated and i would be on my toes for sure. NOt saying not to do it but im more worried about perfusion. Maybe its just my in experiance so please chime in

 

[redcrossemt]

I'm not sure I agree with a 12 lead being the "first thing" I'd do with a symptomatic bradycardia. I'd probably put on a 4 lead and pacer pads and start treating. Then get a 12 lead when I get a chance. I know a 12 should take long but often, especially with an inexperienced partner they are untangling leads, dealing with sweaty skin for stickers etc.

You don't need a 12 lead for basic rhythm interpretation, a 3 lead will do as a first step.

So you are going to start pacing and then turn off the pacer to get a 12-lead later? Let's get the 12-lead now! As someone said above, the patient has a pulse and a problem so get a 12.

 

[MasterIntubator]

If they are symptomatic enough to require pacing, then my 12 lead will take a back step. If I have some time and that person is still talking and death is not looking at me, then I would have time for a 12.
Just like in the cases of NSTEMI I have had... the only slow down in treatment was the ER getting chems to solidify a cath lab trip.

 

[Kidquick]

My thoughts are that this is a patient that needs immediate TCP. Is a 12-lead going to change my course of treatment? If they are not having chest pain then probably not. I'd get some benzos onboard and pace enroute the ER...this patient needs a pacemaker.

 

[piranah]

12-lead wont matter if as your taking the time to get it they code....i would immediately pace and consider atropine but it won't work....12-lead takes a back step when it comes to unstable bradycardia

 

[redcrossemt]

What if the bradycardia is from hyperkalemia? Or from an MI?

"Unstable" bradycardia will often present with chest pain, diaphoresis, shortness of breath and other symptoms also associated with myocardial infarction.

Do you want to use a temporary "bridge" treatment that may make their condition worse and delay root cause oriented treatment? Think about increasing the patient's cardiac workload in the case of AMI or just delaying treatment of severe hyperkalemia which you could have provided.

 

[MasterIntubator]

All good points. And that is where the re-evaluation stage comes in.... after I pace them.

 

[Melclin]

How often do you guys use pacing?

We don't have it here and I've wondered if its just an issue of cost vs frequency of use.

 

[Aidey]

So you are going to start pacing and then turn off the pacer to get a 12-lead later? Let's get the 12-lead now! As someone said above, the patient has a pulse and a problem so get a 12.

I'm with this. Getting that 12 lead actually plays a HUGE part of the patients later care. I can't remotely activate the cath lab based on symptomatic bradycardia and a 3 lead. I have to have a 12 lead. So that 12 lead can save a lot of time later.

Plus, once I've started pacing a patient, there is no way in heck I'm going to stop to get a 12 lead, and the MD isn't going to be happy if they have to do that either. What happens if you pace them, and when the hospital turns off the pacer to get a 12 lead there is no underlying rhythm anymore?

As far as how often, not often, but there isn't an expense concern since its a built in feature on our Lifepacks, and I'm pretty sure you can't get one without it. Well, one that was manufactured within the last 15 years.

 

[MasterIntubator]

In the early 2000's, we used pacing very regularly. Believe it or not, we used to automatically set the pacer on asystole pts while we do CPR... it worked quite well... both mechanical and electrical stimulation seemed to get many going a bit faster without as many meds.

Pausing or even stopping the pacer has not been a problem in the past for me.... I just start it back up. I can apply the 12 lead during pacing.
I suppose that any initial rhythm documentation early on before pacing can be lost.
Honestly, I very rarely have had a pt where I had to jump to immediate pacing... most all have had an extra 30 seconds for me to get a 12 and set up for pacing.

 

[Shishkabob]

Believe it or not, we used to automatically set the pacer on asystole pts while we do CPR.

We still do for asystole. No harm caused, and it might help.

 

[MasterIntubator]

It does... but the bookworms frown upon us doing it since the 2005 recomendations, and its hard to explain to QA/QI why you did it, when its in writing that AHA no longer recommends it.

Sucks... cause it seemed to work for us many of times

 

[Aidey]

I thought what they found was that it did result in an increase on scene ROSC, but had absolutely no affect on the number of people discharged?

 

[redcrossemt]

Pacing is an option, and a fairly expensive one, but one of the most common features on monitors sold in the USA. We don't use it very often, but it can be lifesaving so I assume that's why most areas have it. It's also a recommended ACLS intervention for symptomatic bradycardia...

 

[MizRizQuick]

When you have 5 fire/medics on a truck you have to give them something to do. "You're starting the line, you're bagging, you're drawing up meds, you....uh...do a 12 lead I guess."

Maybe.

This is why I work for a private ambulance service.

"You're getting out, you're getting out, you're getting out, you're driving". End of story.

 

[boingo]

I thought what they found was that it did result in an increase on scene ROSC, but had absolutely no affect on the number of people discharged?

Exactly. We were looking over our cardiac arrest data from last year recently, and no patients with asystole as there presenting rhythm survived to discharge. We had plenty of ROSC, but 0% survival.