GI Bleed =12 lead?

[Fox800]

What are your thoughts on performing 12-lead ECG's on patients with GI bleeds? I'm not talking about "everyone gets a 12-lead just to be safe", I am looking for actual risks/concerns that would warrant a 12-lead vs. just 3-lead monitoring. A fellow coworked was dinged for not doing one and I'm left scratching my head. Assume no obvious cardiorespiratory sympyoms/history.

[Niftymedi911]

I'm not quiet sure..... although it would make sense to cover all basis, I guess maybe to check for cardiac involvement with ischemia in the leads due to the hypovolemia in the leads?

[Dustdevil]

How old is the patient?

[mobey]

Age is definatly a factor, I would also wonder if they were experiencing any abd pain or cramping, pain/discomfort anywhere in the torso can be an indicator for a 12 lead.

[Fox800]

How old is the patient?

I honestly don't know how old the patient was. But more to the point, would a GI bleed alone significantly alter your decision to perform a 12-lead ECG?

[defib_wizard]

It would depend how he presented. Indigestion or epigastric pain = 12 lead

[Dustdevil]

I honestly don't know how old the patient was. But more to the point, would a GI bleed alone significantly alter your decision to perform a 12-lead ECG?

No. But I can almost guarantee you that it was not the lone factor behind the criticism. Consequently, we have to find the rest of the story.

Also, what exactly does "dinged" mean in your system? A reviewer simply asking if that might not have been an appropriate move for this particular patient wouldn't really be the same thing as getting chewed out, written up, or suspended.

[Fox800]

No. But I can almost guarantee you that it was not the lone factor behind the criticism. Consequently, we have to find the rest of the story.

Also, what exactly does "dinged" mean in your system? A reviewer simply asking if that might not have been an appropriate move for this particular patient wouldn't really be the same thing as getting chewed out, written up, or suspended.

Dinged as in had points taken off for his call evaluation. No writeup or suspension. I'll try to get the rest of the story.

[Dustdevil]

I'll try to get the rest of the story.

Cool. To answer your question as asked, I would say no. That presenting sign alone, with no other significant or contributory factors whatsoever, in an otherwise normally healthy young adult, would not make me immediately consider a 12-lead EKG. In an urban system, it would not even come up as a thought before I had gotten a couple of IVs established and arrived at the hospital. And I think that anyone suggesting you delay a scene time to do so should probably stay behind their desk rather than coming to the field.

But again, I'm betting there were indeed other significant factors for it to have been brought up. We have to remember that there is no law against having two or more medical conditions at one time. Just because someone has a GI bleed does not mean they cannot have a cardiac event too. So if the patient is experiencing any s/sx that would cause you to run a 12-lead in the first place, they cannot be written off to the more obvious condition.

[chbare]

Another concept to consider: Anytime we have a hypovolemic patient, that patient is essentially having a stress test. Depending on the situation, a XII lead would in fact be an important part of the assessment.

Take care,

chbare.