LP 12 .... ? 6 lead ?

[armymedic571]

Tskstorm,

I think part of the problem here is that your applying an old trick to new technology. In the past this would be appropriate. But in the world of 12-leads doing a 6-lead would be considered bad form. I think the time difference in using the other six leads is negligible in the fact that in the end if you decide to do a 12/15/right sided lead then you are actually wasting time.

As stated before, unless you've lost your cables, or you have equipment failure. Don't bother.

[kevkei]

From my understanding you attach the limb leads then hit the 12 lead button twice, no moving of leads ... The chest leads, v1-v6 wouldn't be visible but your augmented leads would ... Whether or not there is a benefit is another question.

ST elevation on a 3 lead is non-diagnostic from what I've been told, when you do a 12 lead it is diagnostic. So would this 6 lead be diagnostic? Would ST elevation in this 6 lead be diagnostic, would save you a few seconds and I do literally mean a few seconds before the chest leads for the 12 was put on ...

The simple answer is yes, this would be a diagnostic '6' lead as it is done in diagnostic mode. I'm assuming that this was brought up as simple trick for doing a 'quick' look. I employ it frequently.

It isn't meant to replace a 12 lead, it's simply half of the 12 lead from your four limb leads. Most importantly it gives you a good view of the inferior portion of the left ventricle through II, III and aVf, which to some is important relating to nitrates - but you also see lead 1 and aVl which combined covers the lateral aspect of the LV. I find it's helpful if you need to do a lot of prep on the patient, such as remove clothing, shave chest hair, wipe and clean skin, etc. (this can easily be another 3+ minutes). Since we stratify either to PTCI or prehospital thrombolysis with STEMI, it can help get the ball rolling in deciding which arm we will utilize.

Since a common order is placing the limb leads first, maybe doing an initial set of vitals (SpO2, NIBP, EtCO2), further history and physical exam, then decide to do a 12 lead.... What's the harm in a quick peek?

I don't think it's lazy at all or poor use of equipment, I think it's an example of thinking outside of the box and using the technology to your advantage.

JMHO

[croaker260]

I read this on another forum

Anyone ever heard of this? or done it ?

I will be attempting it at work tonight just to see it ... (almost all of my patients get 12's anyway)

This is where you get the EKG on, press the 12 lead button twice(wich is an over-ride function)and then you move him. It prints out I, II, II, AVL, AVR, and AVF, but leaves your pre-cordial leads blank. it is in diagnostic mode. You dont get an analysis.

Seen it done. Done it myself even. Basicaly on a criticaly unstable patient in a place you dont want them (like the bathroom on the toilet), where they are profusely diaphoretic and you would spend 5 minutes getting the precordial leads to stick......but you need to move him now.

It is almost always followed by a full 12-lead as scene dynamics permit.

It is not a "poor mans 12 lead" to see if you need to put a full 12 lead on, which I have heard mentioned before. If you have that much of a suspician, then do a full 12 lead.

Is it ideal, no. Should a 12 lead always be done if you are doing this? I would say yes. Is this a good 5 second bridge action in a cramped place with an unstable patient, it is better than nothing.

Edited November 10, 2009 by croaker260

[EMS49393]

I've done it before, not often, but a few times. I've had damaged cables before, and they had to have been damaged on the interior, because they looked just fine, meaning without fraying, etc. I wanted something remotely close to diagnostic so I could finish the call and get a set of cables that actually worked.

The other times I've done it have been while waiting for patient prep. If I have a patient that requires a good shave to get the pre-cordial leads attached, I often hit the button while I'm doing other patient care procedures and waiting on my patient to be prepped. I certainly don't stand there and stare at it until it spits out or worry if it's a little wonky, since I plan on getting a decent tracing as soon as the patient has had his shave. It's the ADD in me, I have to have several things going on at one time to be happy.

Edited November 10, 2009 by EMS49393

[FireMedic65]

I think this could make a great addition to the Tutorial section.

Although it is not a for sure tool for treatment, but like other had said, when you are in a pinch. Maybe explain how to use the the 12 lead monitor to do anterior (moving certain leads to the back) and using LP10 to do a 12 lead (in case your 12 lead capable monitor fails).

Just an idea...

[celticcare]

Whilst not the same, we had our limb leads set up in a diagnostic mode in CCU in the days after infarct to continually give the six lead views without the patient being permanantly attached to precordial leads.

I am going to check this out with the LP 12 at work, I like the idea that if you have suspicion, you can get a look in, and remember you only need 2,3 and AVR to diagonose inferior MI.

I am just worried if anything might void the warrenties on products pressing the button when its not supposed to be used that way, we know how some medical companies get with products.

Good thread idea though, just curious are some people reading this as that you are attaching 6 leads *wires and electrodes* to the chest or gaining 6 views of the heart?

Scotty

[Kiwiology]

Basically on a critically unstable patient in a place you don't want them (like the bathroom on the toilet), where they are profusely diaphoretic and you would spend 5 minutes getting the precordial leads to stick......but you need to move him now.

Is it ideal, no. Should a 12 lead always be done if you are doing this? I would say yes. Is this a good 5 second bridge action in a cramped place with an unstable patient, it is better than nothing.

If your patient is that unstable and in a snafu position like that you're going to spend time piss arseing around getting a rhythm strip rather than extricating the patient to the ambulance to work on him there?

Not only do you have to content with a sick patient, trying to get him into an extrication device like the scoop or stair chair but you've now also got to work around the ECG cables and find some hands for the twenty kilo's of gear you have with you too; and for what, a waste of time that tells you your patient is crashing and needs treatment you can't give because you're all tied up trying to get him out the bathroom?

Would it not be far better to get that doubled up, grey, sweaty person to the ambulance and in a position where you can do a proper assessment and treatment, heck I think so.

I am going to check this out with the LP 12 at work, I like the idea that if you have suspicion, you can get a look in, and remember you only need 2,3 and AVR to diagonose inferior MI.

Just don't drain down the battery doing 12 leads on yourself only to have the station tones go off for a 10 hmm if memory serves 118 has one of Mt. Wellington's batteries in their Lifepak lol.

Heck maybe we can find an aging LP10 out there and do a 9 lead

[croaker260]

If your patient is that unstable and in a snafu position like that you're going to spend time piss arseing around getting a rhythm strip rather than extricating the patient to the ambulance to work on him there?

Not only do you have to content with a sick patient, trying to get him into an extrication device like the scoop or stair chair but you've now also got to work around the ECG cables and find some hands for the twenty kilo's of gear you have with you too; and for what, a waste of time that tells you your patient is crashing and needs treatment you can't give because you're all tied up trying to get him out the bathroom?

Would it not be far better to get that doubled up, grey, sweaty person to the ambulance and in a position where you can do a proper assessment and treatment, heck I think so.

Because it takes 5 seconds to look and see if I am dealing with a severe brady, a tachy (SVT, VT)or something else and make the decision if I'm going to go out to the ambulance, or stop in the front living room and try to get a head of the game there. Also because by the time you yank this poor son of a bitch even into the living room, you now have blown 5 minutes in many cases ... 5 minutes where your partner can be setting up something for you, like meds, or pacing pads, or anything...

Its just different styles, but I cringe when I hear people make up excuses why they didn't get vital information because they were doing something else...

There are times when I would do a snatch and grab, as you mentioned, but haveing a basic idea what is (or more importantly ...isnt) going on in the first 2-3 minutes is helpful. And as for getting tangled up in the EKG, thats why the leads are detachable from the monitor.

Edited December 12, 2009 by croaker260

[celticcare]

Because it takes 5 seconds to look and see if I am dealing with a severe brady, a tachy (SVT, VT)or something else and make the decision if I'm going to go out to the ambulance, or stop in the front living room and try to get a head of the game there. Also because by the time you yank this poor son of a bitch even into the living room, you now have blown 5 minutes in many cases ... 5 minutes where your partner can be setting up something for you, like meds, or pacing pads, or anything...

Its just different styles, but I cringe when I hear people make up excuses why they didn't get vital information because they were doing something else...

There are times when I would do a snatch and grab, as you mentioned, but haveing a basic idea what is (or more importantly ...isnt) going on in the first 2-3 minutes is helpful. And as for getting tangled up in the EKG, thats why the leads are detachable from the monitor.

Thank you, exactly right. If you know you can do a bit of stabilising in an emergent sense in the lounge and then get them out to the truck then go for it. Rather know that if I had an SVT that I got them out of the cramp spot, into the lounge, do some stabilising, stretch them out, put them on stair chair properly and then get them to the truck. Its case by case but would rather know I had a bit of an Idea what I am dealing with and could have complications wise before going to the unit. And in reality, someone reading that might think "oh hell thats taking ten minutes" when in reality, the process would be a minute, takes longer to explain something than do it.

And Ben, implying my new job,

[Kiwiology]

Thank you, exactly right. If you know you can do a bit of stabilising in an emergent sense in the lounge and then get them out to the truck then go for it. Rather know that if I had an SVT that I got them out of the cramp spot, into the lounge, do some stabilising, stretch them out, put them on stair chair properly and then get them to the truck. Its case by case but would rather know I had a bit of an Idea what I am dealing with and could have complications wise before going to the unit. And in reality, someone reading that might think "oh hell thats taking ten minutes" when in reality, the process would be a minute, takes longer to explain something than do it.

You make a good point and I'd have to meet you halfway on that; I did have visions of somebody spending forever-and-a-day on the floor of the bathroom pissing about with ECG cables when their patient is circling the drain about to go down the loo.

The more I think about a quick look-see to rule out an inferior MI before giving GTN would be handy, but, if your patient is sick enough to forego the time it takes to do a 12 lead, chances are they are too hypotensive to get GTN anyway!

While I am certainly no authority on the subject seems to me with the exception of an inferior MI, if we are looking for quick rhythm obtainment in a critically sick patient a 3 lead would work just as well so we can rule out say VT or a bradydysrhythmia as the cause of there problem.

.... anyway I still say we find an old Lifepak 10 and do a nine lead!