prehospital electrocardiogram in acute myocardial infarction

[Just Plain Ruff]

I Believe that this is a new study out there. Cited in numerous other articles. but not sure of the date.

Enjoy

http://content.onlinejacc.org/cgi/content/abstract/29/3/498

[Ace844]

greta article "Ruff,". Recently there has been soemthing I have noticed with pre-hospital ECG's in the ER. It seems that the gain is set really high on the 'strips' for patients that they are bringing in, and that most of th ER docs here seem to be wanting numerous 'in-house 12 leads' no matter if they agree with what they see on the ESM one, before making major intervention decisions. Has anyone else been seeing this as well?

Out here,

ACE844

[Just Plain Ruff]

thanks

[Ridryder 911]

Interesting study, especially out of the range number that the number that was studied. As well, why there is such a change of attitude and thinking. There has been previous studies, as well demonstration Paramedics has an higher accurate interpretation over ER physicians.

Maybe more studies will be presented on why, ER physicians are "lagging" and not taking quicker action.

R/r 911

[flight-lp]

I think this is why we are starting to see an increase in agencies bypassing the ER and going straight to the cath lab. Completely eliminates the "slow" factor. Several hospitals in Houston are doing this and the time to revascularization is remarkable.........

[whit72]

Just an EMT here, but isn't the first 12 lead critical due to the fact that it was done hopefully at the onset of the symptoms. Are these not used as a marker to determine EKG changes as treatment continues?

[mediccjh]

I think this is why we are starting to see an increase in agencies bypassing the ER and going straight to the cath lab. Completely eliminates the "slow" factor. Several hospitals in Houston are doing this and the time to revascularization is remarkable.........

University Hospital in Newark is going to be starting this. During the day, the 12-Lead is beamed to the Cardiac Cath team AND the doc in the ER, and they make the determination whether or not the pt is going to the ER, or straight up to the cath lab. Unfortunately, being that I work at night, all my patients are going to the ER.

Lehigh Valley Hospital in Allentown trusts our 12-Leads for the most part. We don't have telemetry capabilities, but as long as we tell the doc our findings, they will usually call the MI alert based on our recommendation. It has saved some of my patients.

[AZCEP]

Just an EMT here, but isn't the first 12 lead critical due to the fact that it was done hopefully at the onset of the symptoms. Are these not used as a marker to determine EKG changes as treatment continues?

It can be used that way, but often it will be used to compare to previous ECG's. Which we always have available prehospital, right? :wink:

An early obtained 12 lead can help to guide what treatment is doing, and what treatment should be tried. As we go through the MONA diatribe, if we see changes to the ECG with the relief of pain, then we can consider changing our steps a bit.

If we don't do a twelve lead, we can't determine the changes as easily, and we will continue down the protocol without doing much thinking for what is happening.

Great question by the way.

[Ace844]

"AZCEP,"

Great points, I'd also like to add the following others for 'whit' to consider which I posted earlier in another thread.

"DustDevil",

I recently sat thru an EM lecture taught by the director of the RI Hosp. ER. This lecture was on "Risk stratification of chest pain patients, treatment modialities and litigous risk." Essentially what it boiled down to in regards to this discussion is this. 1.) A 12 lead ECG is 98% specific and 50% sensitive. In short, just because you have a "normal" 12 lead doesn't mean your patient isn't having a myocardial event.....As a matter of fact, you could get the same senseitivity of info by a simple coin toss.... (Remeber: the 12 lead is just a snap shot of a few millisecond in time)B.) This is why one needs at least 3 sets of - enzymes and a period of observation, "to rule out" if you will. c.) Tort law has now made it a pateint's "right" to be pain free. It is your duty to try to alleviate it. D.) The "pain" felt in MI can and will usually absolve when the underlying etiology has been appropriately treated, i.e.: MIO2 has been restored with blood flow, etc... The reason most often MSO4 is given isn't so much for the minimal vaso-dilitory effects as anxiety control, and "perception of pain decrese".

Lastly, your decision to treat or not to treat a CP patient's "pain" should have nothing to do with whether you have chnages on the 12 lead. As a matter of fact there is an overwhelming amount of evidence which shows that pain can completely devoid of an ischemic event...

Hope this helps,

Ace844

Hope This Helps,

ACE844

[Medic26]

Thanks for the info......

At my service we are unable to transmit however from our report the ER docs generally recommend a STEMI alert if its indicated. Our local facility is recently accredited as a chest pain center and this has been a hot topic for them. We are currently researching the best way to transmitt 12 leads to the hospital and will most likely see this happen by years end.

As far as treatment of chest pains with morphine, if they still have pain when I get to that step I call for it regardless of the 12-lead. The docs generally order it if indicated.