12 Lead EKG Analysis

[p3medic]

All chest pain, huh? Glad that isn't my policy.

[ERDoc]

Regardless of the 12 lead unless you have the ability to check cardiac enzymes on your truck all chest pain should be treated as cardiac related. You would not withhold oxygen from a asthma pt with obvious diff breathing that had a saO2 of 100%.

Are you going to give aspirin to a patient with a disection?

[bufordkid57]

Unless working in a rural setting, with protocals that allow you to give fibrolytic therepy, such as TNKase. Prehospital treatment doesn't change. In my opinion as a paramedic, If the pt. is stable (decent BP,HR, A+O) then yeah, print one off. Inturpretting isn't that important, because the main goal is to cut time down on difinitive treatment for the physician because again, treatment will not change. Time is tissue my friend.

[Ridryder 911]

Unless working in a rural setting, with protocals that allow you to give fibrolytic therepy, such as TNKase. Prehospital treatment doesn't change. In my opinion as a paramedic, If the pt. is stable (decent BP,HR, A+O) then yeah, print one off. Inturpretting isn't that important, because the main goal is to cut time down on difinitive treatment for the physician because again, treatment will not change. Time is tissue my friend.

I would argue with you, but it is obvious you do not understand cardiac care and therefore it would be fruitless. Yes, time is muscle and so is increasing damage to myocardial muscle if one administers NTG to a damage right side infarct and it has to compensate.

I don't know how long it takes you to perform a XII lead but the additional 30 seconds to 2 minutes definitely makes the difference in my treatment, expectation, and assessment of my cardiac patient. There is a difference between angina and true AMI, and the old saying "those that view in leads 3; can't see"...

If time is such an issue... why even take the time to place them on the monitor, why not just scoop and run...? Then again, you described .." interpreting* isn't that important"..

I bet you still return with lights and sirens as well...

R/R 911

(*corrected spelling error)

[reaper]

Rid summed it all up.

If you want to think like that, then drive a taxi!!. I tend to treat my pt's for what they have, not just run through the cookbook!!! :roll:

[JakeEMTP]

Interpretation of EKG's isn't important? You'd last 2 minutes working in my County with that attitude. Never mind, every patient with chest pain meets MONA right? :roll:

[Dustdevil]

I would argue with you, but it is obvious you do not understand cardiac care and therefore it would be fruitless. Yes, time is muscle and so is increasing damage to myocardial muscle if one administers NTG to a damage right side infarct and it has to compensate.

Definitely. This sounds like somebody who never learned to read XII leads trying to make himself feel better about this lack of knowledge. Nobody with a true understanding of XII leads and cardiac care would ever attempt to argue this point.

[firefighter523]

ER Doc wrote: "Are you going to give ASA to a pt with a disection"?

Someone with a possible disection is usually going to present with almost the same signs and symptoms as ACS. Chest pain, pale, cool, diaphoretic.

Your answer is yes, I do not have x-ray vision. And then I would proceed to give him nitrates, to decrease his preload, and to vasodilitate, and then I would proceed to give him 2 to 5mgs of MS to decrease his pain, and to decrease preload of the possible disection! If you cant differentiate ACS from disection, you must give ASA in the field. Sorry Doc.

[firefighter523]

Rid wrote : You would increase myocardial workload if you give someone nitrates with a right sided MI, so the heart has to compensate. "

If you give the patient FLUIDS like you are supposed to before you give the nitrates "cautiously" you hopefully will be ok" Fill the tank, then vasodilitate, "know it all" and quit picking fights with people!!!

[vs-eh?]

ER Doc wrote: "Are you going to give ASA to a pt with a disection"?

Someone with a posible disection is usually going to present with almost the same signs and symptoms as ACS. Chest pain, pale, cool, diaphoretic.

Your answer is yes, I do not have x-ray vision. And then I would proceed to give him nitrates, to decrease his preload, and to vasodilitate, and then I would proceed to give him 2 to 5mgs of MS to decrease his pain, and to decrease preload of the possible disection! If you cant differentiate ACS from disection, you must give ASA in the field. Sorry Doc.

What are some questions you might ask a patient or assessments would you do to query a thoracic aortic dissection over say ischemic CP (myocardial)?

If your patient had certain clinical signs or say they had "tearing" CP to the back (as an example) could you (would you) withhold tx with asa given a reasonable clinical suspicion? As long as you can rationalize your reason from withholding asa (which is the ONLY drug that decreases mortality in the event you are giving it), then don't give it.

The very fact that you mention specific drug doses of say morphine, leads me to believe it has nothing to do with real clinical evidence and everything to do with what YOUR specific, by the book protocols say to do. Mine say I CAN give 2mg q 5....I generally don't...and what about fentanyl?