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

[vs-eh?]

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"?

It must be awesome to work in a system where you could literally ask 20 single questions (CP? SOB? dizzy? hives?) and be able to treat in 3 minutes with every drug available.

I would NEVER work in a system where you HAVE TO administer a drug given a "chest pain" PROTOCOL. Now you're adding the "cardiac history" thing but whatever. It's a fucking joke. You probably also HAVE TO blast them in the face with 10-15L/min of oxygen.

This shit is such a joke.

[Miz Black Crow]

*hangs her head in protocol-shame* The only reason to give O2 via NC is if the pt is unable to tolerate an NRB.... That's also partially because BLS doesn't get O2 saturation, blood glucometry, we don't even *think* about combitubes.... Hell, my company is too cheap to give their *ALS* glucometry.... This is a large part of why I'm going to medic school when I can afford it, because at this rate I can't afford not to.

~Miz Black Crow

[vs-eh?]

*hangs her head in protocol-shame* The only reason to give O2 via NC is if the pt is unable to tolerate an NRB.... That's also partially because BLS doesn't get O2 saturation, blood glucometry, we don't even *think* about combitubes.... Hell, my company is too cheap to give their *ALS* glucometry.... This is a large part of why I'm going to medic school when I can afford it, because at this rate I can't afford not to.

~Miz Black Crow

When you have 2-3 year of college/university EMS education, come back to me. The above speaks volumes...

[JPINFV]

*hangs her head in protocol-shame* The only reason to give O2 via NC is if the pt is unable to tolerate an NRB.... That's also partially because BLS doesn't get O2 saturation, blood glucometry, we don't even *think* about combitubes.... Hell, my company is too cheap to give their *ALS* glucometry.... This is a large part of why I'm going to medic school when I can afford it, because at this rate I can't afford not to.

~Miz Black Crow

At what rate? Have you thought about taking out loans to pay for your education?

[DwayneEMTP]

This shit is such a joke.

Like the majority of your arguments.

Your entire contributions to the forums come in two forms..

"Having religious beliefs is stupid." Or "EMS in the U.S. is stupid."

Both of which you run away from like a scared child the first time you're intelligently challenged.

At least MBC makes an attempt to express her opinion openly, and continue with them even when they're unpopular. In this, at the minimum, she shows she has bigger balls than you. You should leave her be. But of course you can't pass up the oportunity to pick on the new folks.

You've shown on nearly every occasion of your postings that you are unable to sustain an intelligent conversation that involves any type of logical progression or support of what you claim are "facts", unless you're parroting someone before you...

When you complete any amount of college/university that allows you to form a rational opinion, express it clearly, and then defend it to a conclusion...come back to me.

Until then, toodle on back to the kiddy table.

Dwayne

[Scaramedic]

OK, boys and girls everyone play nice because I can see this thread is going to shit real quick.

1. VS. Yes, we all know your superior to us in every way. Sadly no one cares.

2. a. Black Crow welcome to the city. Love the avatar, I am a true Brown coat.

b. Long before Pulse Oximetry we didn't need machines to tell how much O2 to apply. We didn't need them because we could look at our patient and gauge their oxygenation status by such things as skin color/pallor, respiratory rate, general appearance and LOC. Please do not rely to highly on the machines they can be wrong. Go with your training and gut instinct. ALL patients do no require a NRB, in my opinion most do not. In fact, a majority of your patients don't even need oxygen. Watch your patient not the snazzy numbers on the box.

3. Dwayne. VS thrives off stirring up shit. Ignore him and he goes away.

Now everyone back to their corners and get back on topic.

[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:

[align=center:65ea16d291]HELLOOO, think we could get back on thread ...?[/align:65ea16d291]

[align=center:65ea16d291]I DOUBLE DAWG DARE ANYONE TO DEBATE WITH ME HERE, YOUR DELAYING TRANSPORT AND HURTING YOUR PATIENTS ![/align:65ea16d291]

ps I always tell my kids, cursing is for those that have a very poor vocabulary.

[tniuqs]

b. Long before Pulse Oximetry we didn't need machines to tell how much O2 to apply. We didn't need them because we could look at our patient and gauge their oxygenation status by such things as skin color/pallor, respiratory rate, general appearance and LOC. Please do not rely to highly on the machines they can be wrong. Go with your training and gut instinct. ALL patients do no require a NRB, in my opinion most do not. In fact, a majority of your patients don't even need oxygen. Watch your patient not the snazzy numbers on the box.

Positively and Absolutely I whole Heartedly DISAGREE !

Pulse oximetry is a Vital Sign..... everywhere ! If one looks to the studies it is abundantly clear (ps these studies were done in the US btw!) and by experianced flight Medics and RNS, yes clinical judgement is clearly a guideline when Dyspnea or SOB c/o but when the flyboys/girls and can't identify Cyanosis until those that are truely hypoxic and cyanosed until they are a life threatning < 77%. Its a proven fact JACK, the reliability factor is wholy based on perfusion and the complete understanding of the device, its only as good and reliable as the practitioner that is using it ! say JUST like the 12 lead EKG .....

But this TOO is a side bar and excuse me for getting off track, the topic is 12 leads ! sheesh.

[sledogg1]

All I have to say is WOW! Now from what i have been thought and follow is treat the pt not the machine. He is having c/p simular to previous M.I's, and has an extensive cardiac hx, for the love of god treat it. As for the absence of elevation in the 12 lead, I would agree with possibility of non-stemi mi. The only reliable way to rule out an MI is through labs.

I agree, listen to your pt. He is probably on blood thinners so ASA is not a big deal if not sure give it to him unless other contraindications. Give Nitro, DO A 12 LEAD, has he gone into CHF or cardiogenic shock call ALS so next steps can be done if needed......m/s salbutomol, lasix TNK.

Sounds like lazziness

[Ridryder 911]

I suggest everyone should read the article "Relying on your H & P; Are we losing the art of clinical medicine technology" in this months JEMS.

Basically addresses that we place too much emphasis on what the numbers are versus to good interviewing and assessment techniques, thus having good diagnostic skills.

I do believe that an ECG is a lot different than using a pulse ox. Is there going to be any change in treatment from the pulse oximetry finding? No. In that regards do you use & monitor EtCO2 on patients? It is much more accurate on the respiratory system.

Now in regards to the ECG monitor.. yes. Not just treating what is on the monitor but it as an asset to making the diagnosis, where pulse oximetry is what? You should have known they were already hypoxic, but again one may not realized they had a bifasicular block with that AMI.

It takes an additional 45 seconds to perform a right side, to be able to determine the extent and location. Will this change my treatment modality... you bet. If they are borderline hypotension no NTG, no morphine but an alternative medication. Will this change the receiving hospitals plan .. yes. This is a cath lab patient, and if possible avoidance of thrombolytics. Thus when I notify ER, they can prepare for such and delay can be reduced.

Much more reduced time, than me sitting and getting a right & posterior ECG. Again I believe many place ER treatment way above the field setting, when in reality there maybe no to little difference.

Again, there are times to utilize our equipment as "tools" to aide us. Knowing when and how much is the key.

R/r 911