louiss

Hello,

Our CVA protocol states "Obtain 12 lead EKG if available".

I'm wondering if yours said the same would you try and obtain one for every CVA patient? What are the reasons you would or would not obtain one?

I think it's an interesting choice to possibly find a cardiac problem while delaying the PT from receiving care for the CVA at the hospital. Personally I think there should be an indication for it like seeing AFIB on the ECG or the PT having a complaint that prompts it (weakness, dizziness, cp, SOB). I'm not sure what the odds are of a PT having both a STEMI and a CVA at the same time but it seems like if they are presenting with an obvious CVA/TIA transporting early and avoiding an EKG seems the best choice.

What do you think?

Well the interesting thing about CVA's in the field you do not know if you have a bleed or ischemia, 12 lead evaluation of the patient can lead to some ekg changes with some cerebral bleeds which you would see severe ischemic changes in the V leads, it takes less than a minute to do a 12 lead and that can be done enroute to the stroke center, your treatment is going to be supportive anyway. Just remember you can have both an infarct and a stroke in some patients.

You hear it a lot to put altered patient "left lateral" or in "recovery position" but on their left side (even if NOT pregnant).

Is there scientific reason for the LEFT side, specifically?

I was originally told it was to prevent aspiration, but no one can really explain why the LEFT side.

I've heard:

- Stomach curves to the left, so vomit would have an extra curve to overcome

- Stomach curves to left, so contents won't be pushing against sphincter.

- In the ambulance, attendant can watch him better facing toward him.

- It helps pre-load by not having thoracic pressure on inferior vena cava

The first two don't quite sound legitimate enough. The third isn't great, because it only applies once patient is on gurney. Fourth does make sense, but it has nothing to do with aspiration and it assumes that all patients are in some kind of blood pressure / preload distress.

It would make sense as a position for a post-arrest patient who is now breathing or shock patients, perhaps. But why is it this big rule I seem to hear all over? Why must it be to the left side?

Look at the anatomy and note that the inferior vena cavae runs up the right side, by putting your patient on the left side it will move contents away from the vena cavae and you have better circulation, especially with pregnancy, the baby is moved off the vena cavae and now mom can get better circulation.

Look at the anatomy and note that the inferior vena cavae runs up the right side, by putting your patient on the left side it will move contents away from the vena cavae and you have better circulation, especially with pregnancy, the baby is moved off the vena cavae and now mom can get better circulation

We had this patient last week who presented with dizziness and loss of balance when standing. He also began complaining of pain in his upper and lower extremities and all 4 Qs of his abdomen. En route he also began experiencing CP. He had no history of MIs or CPs prior, his EKG and VS were all normal. But he did have lung cancer and was undergoing hemotherapy which he had just finished the previous week. Could that be the cause of all his symptomps?

Some things to think about when anyone stands and gets dizzy, does that person have some sort of bleed internally. Pain to the legs could be poor circulation, think AAA or a dissection.