More important IV or 12 Lead?

[Thunderchild145]

Pads? As in defib pads?

You hook up defib pads before they code?

Sometimes. Not often. If I see a truly sick patient who is in a peri-arrest situation, then yes. Also, obviously if I'm going to pace/syncronized cardiovert, then I need them on to do that. This particular patient doesn't seem like they're too bad, but some patients do warrant getting the pads on before they code.

[Connie31079]

Here in Nova Scotia, all levels of paramedic (PCP, ICP, ACP) can do a 12-lead, so I usually leave my partner to do that While I'm getting the IV, especially if the patient is so hemodynamically unstable, that if I don't get the line NOW, I probably ain't gonna get it later!

I normally work with a PCP partner, and I always like to utilize them as much as I can, so I enable them to do all that they can within their scope of practice. Let them get the vitals, 12-lead, etc, while I get the line, good history, listen to the lungs, find out exactly what's going on....we work best as a TEAM!

The I re-assess enroute, and treat accordingly.

Connie

[OVeractiveBrain]

Judging from the flow of the post im probably going to get flak, but im putting in my two cents. The 12-lead is just ONE piece of information that can either help you rule in our rule out ACS. However, regardless of EKG changes, interventions can be performed if the presenting symptoms are indicative of ACS. Of course it always depends, and anyone who says otherwise is a cookie cutter, but personally, id rather have the line than the 12lead if i had to choose. This is in the instance of HAVING TO CHOOSE. Of course i would like a preliminary 12-lead prior to intervention, but I would also like to give a spray of NTG or some aspiring to initiate therapy over diagnostics. This of course leads into many more discussions (do you need a line for NTG, of which I also think no, but lets leave that for another time).

Just as you can obtain an IV enroute, you can obtain a 12-lead enroute. The hospital is going to draw labs and get a 12-lead regardless so I assume this is a hypothetical arguement where both are required. Getting the line first or getting the 12-lead first? Probably provider preference (20 seconds for a line, 30 seconds for a 12-lead). While its useful to think "12 lead for every call" if you dont have time, screw it. It is nice to say "look at this 12-lead before, after intervention 1, after intervention 2, and now" but I dont think the topic of the post is that at all. I assume the initial author was questioning priority of the IV or the 12-lead, or, if only possible (for whatever reason) to only get one, which do you get?

Id say the IV is more important as a portal to initiate therapy, resucitate of the patient decompensates or sufferes an undesired side effect, whereas the 12lead is only a piece of data. A piece of data that is also inconclusive given the abscence of enzymes. If you get a 12-lead that shows STEMI, they might go to the Cath or they might wait on labs. If you DONT have STEMI/NSTEMI theyll still get labs. If you have STEMI (but dont get a 12lead) and one preemptive spray of NTG alleviates the STEMI, youll still see lasting enzymes, have treated the patient, improved their condition, and have enough diagnostic information to initate this patient as a cardiac patient. The point im making is that there are multiple tools you can use to draw a clinical impression of ACS, of which a 12-lead is just one. The IV is the portal to treat the ACS or other maladies should you move in a different direction. Personally, with practice and lucidity you will be able to obtain (as one of the previous posters has said) all your ALS and transport in a short amount of time (i believe 2 minutes to 12lead and 10 minutes to trans, with additional ALS enroute). It doesnt matter how you do it, or what order you do it, really, so long as it all gets done. Enroute or not.

I think an item to stress the most is that even if your transport time to the hospital is 5 minutes, your immediate interventions can save tissue. If trans times are longer you better do everything. If trans times are short, I am of the nature of therapy prior to diagnostics. But if you cannot conclude which illness and therefore which therapy, do another diagnostic. So if youre pretty sure its ACS, go therapy, if you arent, go diagnostic.

In short: it depends. Because i hate that answer: IV.

Overactive

[canuckEMT]

Speaking only from my practicum experiance, IV AND 12 lead can happen simultaneously. Personally, if I am suspecting AMI, I like the 12 lead to be done before the IV. I delegate the ECG after I have done my chest assessment. By the time I am done my assessment, my preceptor would have the 12 and IV done. Then enroute after initial admin of ASA and Nitro, if there was a change in pain level I could do another 12 lead enroute to compare.

Again, that is personal preference and also the way my preceptors wanted things done. It seemed to me like a good use of resources and flow of interventions.

[Dustdevil]

Again, this is all quite situational. As OveractiveBrain pointed out, to say that one is always done before the other is strictly "cookie cutter" medicine for amateurs. Sure, on somebody that presents overtly with an unstable or otherwise strong cardiac picture, we need to get a lifeline immediately. No question about it. But unfortunately, few of our patients are that cut and dried. The vast majority turn out to not be cardiac in origin at all. They have GERD, pneumonia, pectoral muscle strains, arthritis, indigestion, pancreatitis, anxiety, hyperventilation, and volumes of other potential maladies that aren't serious enough to warrant a lifeline, but still give you a few minutes of concern that warrants a diagnostic EKG to make sure you aren't barking up the wrong tree. And again, in that vast majority of cases, the EKG is where I would start. Yeah, I guess if you are a n00b or a wanker, it sucks to figure out that your patient just has a muscle strain, thereby missing your opportunity to start an IV on somebody who didn't need it, but that's life as a professional. Nobody promised you a rose garden.

[Ridryder 911]

Nobody promised you a rose garden.

Geez, I wished that song would make a come back... I wished the newbies and many other realized that real life is like that!

R/r 911

[FormerEMSLT297]

This lays out an argument for 2 medics on a truck. 1 can start the IV while the other does the 12 lead.

I agree with what the others posted, start the IV first. I think that a 12 lead can wait for a minute or 2 or 3 while i start a line. If the patient then goes south, at least I have ready access to push meds.

Just my 2 cents from my 20+ years of ALS experience.

Former

[sledogg1]

I would do a saline lock not a full iv, is this for the nausa???? but again your partner could do the 12 lead and reassess v/s while you obtain a iv, or u can do it enroute if your pt can wait. What was the outcome of the pt, l/s was it CHF or the flu???

[ALERT Medic]

I look at it this way...when was the last time that starting an IV in an ambulance really "saved" anyone's life?

Just do what you think is right. This is a situational question and you're going to get every different answer immaginable. Do what you think is right for the patient.

Just for giggles though, I start my lines enroute unless they absolutely need it on a scene. I don't screw around on scene with things like IV's unless they need immediate pharmacological intervention that only an IV will provide a route for. Only exception is pinned in trauma patients. That's it. I get paid to stick needles in people while in a moving vehicle. The 12 lead gets done on scene while there's less chance for artifact.

[Dustdevil]

Yo, Alert!

Quality post.

Welcome back, Bro!