Using 12 Lead to Rule Out MI: A bad move?

[medicv83]

Few things to examine here.

1. Any variation in cardiac conduction, even with AMI do not necessarily appear right away. As a matter of fact, these changes can take up to 4 hours into the patients cardiac problem to be noticed on the EKG.

2. A pt presents with all the signs and symptoms of an MI. We are talking classic case.

------------DO AN 18 LEAD---------- If you dont know how to do this, find out, because it will help you determine the nature of the problem, specifically stating that the problem could be a RIGHT sided MI, AND, if you decide to treat this cardiac pt with the typical protocol (MONA), the effects of the Nitro could be devastating to the pt.

[IUemt]

Bare makes a good point... when the new heart is put back into the chest how would this patient "feel" any pain from tissue damage in the heart... the other question I have is how is the heart beat regulated is a pacer implanted with the heart every time? or is there enough nerves reconnected that the heart is able to regulate its rate based on the bodies demand and "Feel" tissue damage?

never really thought about transplants before... great topic... Might need new thread?

Interesting topic, can anyone expand on this?

[Miz Black Crow]

Side note from the BLS provider: Where I am, the protocol this patient would fall under would be "Non-traumatic CP", where technically by protocol I am required to give ASA to someone who's been coughing for 3 weeks straight and has worsening CP on inspiration/expiration and the lung sounds like you're listening to a puddle of cowpies, or to the guy who has acid reflux who calls at least twice a week for chest pain. My protocol states "Chest Pain", not "Cardiac-related CP". Why on EARTH would I NOT give ASA to this pt unless s/he meets the ABCD's of ASA contraindications? By my book, ASA, ask for medics, if he has a hx of angina and a sys. BP > 120 (and his own nitro with the 6 rights) an NTG, note to the nearest (hopefully a STEMI center, but then I can't do an EKG as a BLS here) and hope for the best.... If the new heart already has ONE MI, why can't it have another? Then again if everything around it indicates epigastric pain.... my tx still doesn't change. And I'm sure as hell ruling out MI.

~MBC

[BEorP]

Side note from the BLS provider: Where I am, the protocol this patient would fall under would be "Non-traumatic CP", where technically by protocol I am required to give ASA to someone who's been coughing for 3 weeks straight and has worsening CP on inspiration/expiration and the lung sounds like you're listening to a puddle of cowpies, or to the guy who has acid reflux who calls at least twice a week for chest pain.

[sub:4fe51aaa2d]Bold added by me.[/sub:4fe51aaa2d]

Required to give? No judgement is allowed? (And before Dust says it, you're not a BLS provider if you're giving drugs :wink: )

[Mateo_1387]

Side note from the BLS provider: Where I am, the protocol this patient would fall under would be "Non-traumatic CP", where technically by protocol I am required to give ASA to someone who's been coughing for 3 weeks straight and has worsening CP on inspiration/expiration and the lung sounds like you're listening to a puddle of cowpies, or to the guy who has acid reflux who calls at least twice a week for chest pain. My protocol states "Chest Pain", not "Cardiac-related CP". Why on EARTH would I NOT give ASA to this pt unless s/he meets the ABCD's of ASA contraindications? By my book, ASA, ask for medics, if he has a hx of angina and a sys. BP > 120 (and his own nitro with the 6 rights) an NTG, note to the nearest (hopefully a STEMI center, but then I can't do an EKG as a BLS here) and hope for the best.... If the new heart already has ONE MI, why can't it have another? Then again if everything around it indicates epigastric pain.... my tx still doesn't change. And I'm sure as hell ruling out MI.

~MBC

Whaaa :?: :shock:

:arrow: You would follow the cookbook by doing the Chest Pain protocol even if you know that it is not indicated? Even if you feel like you must always follow the cookbook, why not call a doctor and explain to it your patient's condition? Come one guys, we have to be thinkers and do what is right for our patients, not CYA because of what the cookbook says.

:arrow: on another note after the third sentence where you started to ramble about aspirin and medics and stemi centers and abcd's I lost you. Could you clear it up and explain what you were meaning?

[Dustdevil]

^ Precisely why nothing short of a degreed paramedic should be on any emergency ambulance.

[tniuqs]

Ok just to play the devils advocate, and for entertainment sake as well.

1- If you do not carry any Thrombolytics on car, nor bedside troponin for that matter.

2- It has been established that 12 lead can not rule out MI.

3- You have the capability of doing a R sided lead to rule out R sided infarct, talking Nitro here. (besides you can do with a LP 10 or equivalent)

4- One other exclusions.. yes, its a cleaner picture of an BBB, a possible pseudo VT. (but one still can rely on clinical observation for that can't you ?)

So why then would you delay transport to a definitive care center?

We know that patient is progressively infarcting as we speak and any "delay" does cost's more tissue damage?

Are we playing ERdoc ?

cheers

:oops: :twisted:

[Miz Black Crow]

First of all, I apologize for unclear wording, I guess my tiredness got the best of me.

No, I'm not a "cookbook EMT." I'm running the list of my non-traumatic CP protocols. Do I give everyone with a cold or an upset stomach aspirin? OF COURSE NOT. I was just pointing out what the protocols were on a BLS level in my area, and saying that if I follow my protocols as written I have no choice but to give ASA. There is no stipulation to contact medical control for permission NOT to give it, but that doesn't mean I haven't picked up the phone or that I won't continue to. I'm inexperienced, not stupid. I was also pointing out that I would much rather be safe than sorry with this particular patient.

~MBC

[BEorP]

First of all, I apologize for unclear wording, I guess my tiredness got the best of me.

No, I'm not a "cookbook EMT." I'm running the list of my non-traumatic CP protocols. Do I give everyone with a cold or an upset stomach aspirin? OF COURSE NOT. I was just pointing out what the protocols were on a BLS level in my area, and saying that if I follow my protocols as written I have no choice but to give ASA. There is no stipulation to contact medical control for permission NOT to give it, but that doesn't mean I haven't picked up the phone or that I won't continue to. I'm inexperienced, not stupid. I was also pointing out that I would much rather be safe than sorry with this particular patient.

~MBC

[sub:156987e22a]Bold added by me.[/sub:156987e22a]

So the truth is that your protocols are written to require drug administration and not leave you with any judgment?

[Miz Black Crow]

BEorP: If the patient is age 35 or over or anyone of any age with a cardiac hx, I am mandated to give aspirin unless it is contraindicated. There is no wiggle room in my protocols for clinical judgement, on a BLS level (EMT-, nor is there a "contact medical control for orders" clause. Hence why I was expressing my dismay with the protocols. Can you say "exacerbation of acid reflux"?

Be safe!

~Miz Black Crow