More important IV or 12 Lead?

[explenture]

Pt. 65 year old female, diff. breather. 5 LPM NC improves breating. Has headache 10/10, pupils equal, pmsX4, equal grips no facial or arm drip. No chest pain. Had been in ER day before for nausea/vomiting.

I thought a 12 lead was warranted. My preceptor felt an IV was more important. My 12 lead preference was based on the following: A. High incidence of atypical MI in females B. Difficulty breathing C. 12 lead as assesment tool could help guide what the IV would be used for.

So, what's more important IV or 12 lead?

[fiznat]

I think this question can probably be answered even without the example patient. An unstable (or potentially unstable) patient should get the IV first. Otherwise, it probably wouldnt matter which comes first. The IV is a treatment, the 12 lead is a diagnostic. No ED in the world is going to take your side if you come in with a patient who coded and lost all his access and then say "...but I got this great EKG!" If your patient needs the IV, give it to him. Otherwise- do whatever is easiest to do first.

[EMS49393]

I will preface this post with stating that it is the preference of the paramedic to do either the IV or the 12-lead first regardless of whether the patient appears critical or not. I do my 12-leads on just every patient with a pulse and a problem from the neck to the knees. I have a goal of obtaining my initial 12-lead within 2 minutes of patient contact. It's also the standard at my service to obtain the 12-lead in that amount of time and be transporting any critical patient within 10 minutes of patient contact. It's an obtainable goal, and one I have attained numerous times.

The IV, although important, is something I can do en route, and often prefer to do en route. It's to the point now that it is almost more difficult for me to start an IV sitting still then moving around.

My reasoning for my rapid 12-lead is to assist in my assessment, not to mention, I've been bitten when I thought the 12-lead could wait. It's easy for me to perform, it doesn't take me away from continued questioning of my patient, it's usually a clean tracing without movement, and it enables me the opportunity to transmit any STEMI strips with ease if the patient has a land-line telephone. In the case of the particular patient you are speaking of, they would have gotten a 12-lead within 2 minutes of contact, and a 15-lead en route if the 12 was negative.

I had an elderly lady once complain of dizziness and a toothache. She stated she'd been to the dentist and he told her he didn't know why she had a toothache since she had no evidence of decay. Her dizziness subsided while she was supine and I figured she was just orthostatic after admitting to having flu-like symptoms for a few days. I ran my 12-lead after she was comfy on the stretcher, some 13 minutes into contact. She was having an inferior MI. Needless to say, after taking my time in scene with what I thought was a sick lady, she got her IV en route.

I might miss an IV, but I can always get the 12-lead.

[paramedicmike]

The IV is a treatment, the 12 lead is a diagnostic.

I'm going to take issue with the first part of this statement. While I'm almost positive the writer meant something different from what was written, it wasn't conveyed very well.

Placing an IV is *not* a treatment. It provides access in order to administer medicinal treatments. But it is not a treatment in and of itself.

As for which to do first, I think it's very situationally dependent. I'll admit I'm more inclined to do the 12 lead first as part of my overall assessment and place the IV second. But that's me.

To be fair, however, there will be patient's you'll encounter who will get the IV based only on how they look when you walk in the door.

As with everything else in EMS, there are no hard and fast rules on this. Treat each patient on his/her own merits and go from there.

With regards to the original patient in this thread, I wouldn't have done either the IV or a 12 lead until I had a complete set of vitals. Including those might help us determine which way we might have gone in this scenario.

-be safe

[Ridryder 911]

I agree with Mike, it is all dependent upon the situation. As well, who cares which is really done first or simultaneously. Insertion of an IV is more commonly an intervention, rather than treatment as Mike described, as well as a XII lead is part of an assessment tool.

I personally attempt to obtain these basics simultaneously, I rather not administer NTG without a XII lead, checking of course origin of site of potential AMI.

There is more than one medic on the scene, simultaneous things can occur.

R/r 911

[fiznat]

Placing an IV is *not* a treatment. It provides access in order to administer medicinal treatments. But it is not a treatment in and of itself.

Splitting hairs. C'omon, you know what I meant!

haha although acccctually I have seen people vagal out of SVTs on the IV insertion alone! So hah! :wink:

[Ridryder 911]

Splitting hairs. C'omon, you know what I meant!

haha although actually I have seen people vagal out of SVTs on the IV insertion alone! So hah! :wink:

Sure it was the IV?.. .. Back when I used paddles, I used to see them convert just by placing the cold paddles on them... even before I could shock them .. dang!

R/r 911

[Thunderchild145]

All I know is that if I don't have an IV in a code I'm screwed, but if I don't have a 12-lead in a code I'm not missing anything. 12-lead IS warrented though. Don't think that was a bad idea at all. My reccomendation: Start the IV while your partner gets the 12-lead set up. For a patient like this who looks like they are about to code, get an IV and get the pads on.

[akroeze]

For a patient like this who looks like they are about to code, get an IV and get the pads on.

Pads? As in defib pads?

You hook up defib pads before they code?

[Dustdevil]

I agree that this is a situational question, depending upon patient presentation. Somebody who is truly sick in appearance will get an IV first, worrying about narrowing down the diagnosis later. However, on the vast majority of patients I will get the EKG first so I have a clearer picture of where I am headed with my plan. Where I work, I usually have no partner. No medic. No nurse. No doctor. Not even a lowly EMT-B. Just me. Consequently, I have to do everything myself, meaning I have to prioritise more than somebody with a partner. Again, the great majority of the time, I get the EKG first, right after vital signs, and then move on to establishing a line, if necessary. Obviously, I am getting the 3 lead while I am hooking up all those other leads. And if there is something life threatening on the 3 lead, I can move directly to any necessary interventions at that time and worry about the other 9 leads later. But, as correctly stated previously, the IV is not (usually) a treatment. It is just a means to an end. And this early in the game, you don't even know that you have an end to reach.