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

[triemal04]

This may be someone who needs to be reminded to treat his patients, and not his monitor. A STEMI takes time to present itself, and aas has been said, won't be there all the time.

It doesn't change anything at all, but for idle curiosity, what was the final diagnosis?

[Dustdevil]

To answer the original question, yes, using an EKG as your sole or overriding criteria for ruling out an MI prehospital is a poor form. But I would hesitate to criticise this medic without a lot more information about his decision process. If the patient states his pain is "like" his previous 5 MIs, then that should itself lead you to a high index of suspicion. But you certainly cannot let that history give you tunnel vision. Perhaps there were elements of his assessment that lead him to believe it was more likely to be an aortic aneurism? That would completely change the plan. We just don't know from the info given.

But to reiterate, yes, using an EKG as your sole or overriding determinant -- especially with such a significant history -- would be inexcusable.

[BEorP]

This may be someone who needs to be reminded to treat his patients, and not his monitor. A STEMI takes time to present itself, and aas has been said, won't be there all the time.

It doesn't change anything at all, but for idle curiosity, what was the final diagnosis?

I'm not sure. If I find out, I will post it.

[Ridryder 911]

You know what they call practitioners that only use the ECG to r/o an AMI?....

...Defendants.

[SWM_Medic]

I was told by the guy who gave the best 12-L lecture I have every heard it takes three things to justify and cardiac related chest pain.

1. could the chest pain be cardiac in origin. Make sure its not from a cough or what not you all know the questions to ask

2. 12-L changes. Hard to tell since we don't get an old 12-L.

3. Makers in the blood

Now it only takes two out of three to justify our cp protocol. And we can't check the third. So do a good assessment and a good hx. Remember the 12-L is just a tool and we don't treat tools. (okay maybe lawyers but that's not the tool I meant)

[AnthonyM83]

I was told by the guy who gave the best 12-L lecture I have every heard it takes three things to justify and cardiac related chest pain.

1. could the chest pain be cardiac in origin. Make sure its not from a cough or what not you all know the questions to ask

2. 12-L changes. Hard to tell since we don't get an old 12-L.

3. Makers in the blood

Now it only takes two out of three to justify our cp protocol. And we can't check the third. So do a good assessment and a good hx.

I'm a bit confused. You have a chest pain protocol (stuff like nitro, ASA, priority transport, etc?) for which you need to have 2 out of the 3 above in order to implement it? Since you pretty much never have an old 12-lead to compare, wouldn't that mean you never implement it? What happens if there's chest pain, but patient only meets one criteria?

I must be confused on what the "cp protocol" is exactly....

[Dustdevil]

Remember the 12-L is just a tool and we don't treat tools.

I treat my tool very well, thank you.

[mediccjh]

I follow the duck rule: If it walks like a duck and talks like a duck, it is a duck.

If the patient said that his pain was similar to his last MIs, then it's a cardiac workup.

What was the patient's final diagnosis/disposition?

[SWM_Medic]

I'm a bit confused. You have a chest pain protocol (stuff like nitro, ASA, priority transport, etc?) for which you need to have 2 out of the 3 above in order to implement it? Since you pretty much never have an old 12-lead to compare, wouldn't that mean you never implement it? What happens if there's chest pain, but patient only meets one criteria?

I must be confused on what the "cp protocol" is exactly....

Sorry I guess I didn't explain myself very well. This was a guideline for pt's going straight to the cath lab. I was really just trying to make the point that you can't go strictly by what the 12-L says. Yes, we have a standard chest pain protocol that probably the same as everyone else's. It simply says if the pt has chest pain do this, this, this, etc...

[streethealer535]

In addition, a s/p cardiac transplant patient experiencing typical chest pain from an AMI would be a little unusual. Remember, the heart is not directly linked to the nervous system. In many cases, transplant patients will not know they even had an MI.

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?