CVA , do a 12 lead?

[jwraider]

Hello,

Our CVA protocol states "Obtain 12 lead EKG if available".

I'm wondering if yours said the same would you try and obtain one for every CVA patient? What are the reasons you would or would not obtain one?

I think it's an interesting choice to possibly find a cardiac problem while delaying the PT from receiving care for the CVA at the hospital. Personally I think there should be an indication for it like seeing AFIB on the ECG or the PT having a complaint that prompts it (weakness, dizziness, cp, SOB). I'm not sure what the odds are of a PT having both a STEMI and a CVA at the same time but it seems like if they are presenting with an obvious CVA/TIA transporting early and avoiding an EKG seems the best choice.

What do you think?

[chbare]

If somebody has vascular disease significant enough to cause a stroke, it should come as no surprise that the cardiac vascular circulation would also be involved. So, a cardiac evaluation may be warranted for two reasons. Cardiac embolic cause as you stated and concomitant cardiovascular disease. Therefore, I cannot argue against having such a protocol. While a XII lead may not reveal "high yield" information in many of your patients, it is quick, easy, and may in fact help identify underlying or concomitant problems.

Take care,

chbare.

[AnthonyM83]

You can have MI with CVA and you CVA can also show signs in 12-leads. MI's may also appear when one thought the patient was having a CVA, but really just an MI. I'm sure others might have more stats and details, but yes, I would do 12-leads on CVA's if I had the same protocol (duh...)

But even if I didn't, I would still do it if I had the time. They're pretty fast to do..

[Ridryder 911]

Alike CHBare advise, coronary and vascular disease = potential other problems. Your looking at the tunnel and not looking at the whole problem and assessing the whole patient. There is a high incidence and risks of those with CVA's having several multiple problems. Do you not also perform a FSBS as well? You should. There are many related illness and injuries with associated problems. I have seen many CVA's with associated AMI's and other related disturbances. Twelve lead is just simply another assessment tool, should be used on any potential vascular problems.

If it takes one more than 1-2 minutes to perform a 12 lead, then you have technical problem such as they don't how to do their job. Twelve leads never delays care, if one knows how to do them .

R/r 911

Edited July 8, 2009 by Ridryder 911

[jwraider]

Cool guys I'm glad to see some support for the 12 lead backed with some reasons.

In doing some research what is interesting is that there are many many articles stating that an abnormal EKG with a CVA puts the patient at a high risk for mortality in the coming months.

Here is a report with some hard #s:

http://linkinghub.elsevier.com/retrieve/pi...022510X05001206

It also shows the high degree of cardiac problems found in CVA patients.

Here is an article:

http://www.elements4health.com/stroke-pati...f-fatality.html

Looks like a small percentage of patients are actually having an MI and their long term health is also a big concern. But all the same checking a sugar and doing a 12 lead helps ground us in other possible causes of the patient’s condition and avoid tunnel vision that may harm the patient. Also the data shows how likely a CVA patient is to be having cardiac issues at the same time. For me that makes it almost as cut and dry as doing a 12 lead for anyone with chest pain.

a 12 lead should not significantly delay transport

This gets me back to my original question. To me it means medics and EMTs should be adept at doing a 12 lead (individually and as a team) quickly before leaving the scene. It's an important assessment but it can't delay the transport more than a moment or so.

(Anthony I've had that call where the patient was complaining of CP but was also ALOC with facial droop.... yay for $20 an hour for making very important decisions. I used to make $33 hour loading software onto computers but I digress....)

[aussiephil]

It also shows the high degree of cardiac problems found in CVA patients.

Not surprising considering the majority, over 90% from memory, are ischaemic caused by a plaque emboli.

[louiss]

Hello,

Our CVA protocol states "Obtain 12 lead EKG if available".

I'm wondering if yours said the same would you try and obtain one for every CVA patient? What are the reasons you would or would not obtain one?

I think it's an interesting choice to possibly find a cardiac problem while delaying the PT from receiving care for the CVA at the hospital. Personally I think there should be an indication for it like seeing AFIB on the ECG or the PT having a complaint that prompts it (weakness, dizziness, cp, SOB). I'm not sure what the odds are of a PT having both a STEMI and a CVA at the same time but it seems like if they are presenting with an obvious CVA/TIA transporting early and avoiding an EKG seems the best choice.

What do you think?

Well the interesting thing about CVA's in the field you do not know if you have a bleed or ischemia, 12 lead evaluation of the patient can lead to some ekg changes with some cerebral bleeds which you would see severe ischemic changes in the V leads, it takes less than a minute to do a 12 lead and that can be done enroute to the stroke center, your treatment is going to be supportive anyway. Just remember you can have both an infarct and a stroke in some patients.

[speedygodzilla]

Other than reporting your finding to the doctor, how would this change your treatment. I still see it as a must with CVA pts and many others, but if you are suspecting a CVA you can't treat an with ASA or Nitro as that would worsen a bleed. It could make you question your CVA field diagnosis and possibly change your whole treatment. But if I am thinking at all it could be a CVA, I'm not gonna give ASA or Nitro. A majority of CVA's are clots, however since we can't tell 100% I'd rather stick with supportive care.

Nate

EMT-B

EMT-P Student

[tniuqs]

A fib can lead to CVA ....

Implementing the concept ....

Did an injury cause a fall or did the fall lead to an injury.

cheers

If you have bedside coags that would not be harmful either .. go TNT diagnostics !

[nremtp]

We have the option to thrombolyse CVAs although it is done in hospital in most areas. A 12 lead is essential for stroke treatment pathways, so you are possibly being asked for one in order to aid later treatment. You may also wish to rule out co-existing pathologies. Just because they have had a CVA does not mean they don't also have other problems as well.