The Need for 12-Lead: A vague chief complaint turns out to be something more - Patient Care - @ JEMS.com


The Need for 12-Lead: A vague chief complaint turns out to be something more


 
 

Steve Farzam, BA, NREMT-P | From the July 2008 Issue | Thursday, September 4, 2008


At 3:30 a.m., a crew was dispatched to the hotel room of a 54-year-old male. On arrival, the patient weighing approximately 160 lbs. appeared stable and complained only of ˙throat pain.Ó After providing a pertinent history, he explained that he had been a pack-a-day smoker for 10 years. Further, he had just traveled to the U.S. from London on a 12-hour flight.

The non-radiating throat pain, which he described as being a six out of 10, began during a layover. Despite resting for several hours after landing, the pain persisted, prompting the patient's 9-1-1 call.

His vitals all appeared to be within normal limits, except his skin, which was cool, pale and diaphoretic. In fact, the lead-II reading on his ECG was a normal sinus rhythm (see Figure 1). One paramedic felt a 12-lead was warranted due to the unclear chief complaint. However, a senior paramedic on scene felt a 12-lead was not indicated. So, the crew transported the patient to an emergency department (ED) with no STEMI center.

Approximately one hour later, the ED staff performed a 12-lead ECG; it read ˙***Acute Inferior MIÓ (see Figure 2). The patient had quickly deteriorated, and the receiving facility was unable to provide the necessary cardiac intervention. The crew was dispatched to the ED to land an air ambulance and transfer him to the appropriate facility. After a follow-up, the cardiologist found the patient had massive infarcts throughout his heart. The patient succumbed to cardiogenic shock three days after ICU admission.

Discussion

This case demonstrates the importance of 12-lead ECGs, STEMI recognition and rapid door-to-needle time for proper intervention and recovery whenever a provider thinks the incident may be cardiac-related.

The current guidelines from the American Heart Association and American College of Cardiology emphasize the critical role EMS can play in the early detection of acute myocardial infarction (AMI). The guidelines strongly urge EMS providers to routinely perform and evaluate ECGs on chest pain patients suspected to have a STEMI.

It's widely believed that EMS has only three ways of definitively detecting AMI by ECG (ST elevation of 1 mm or more in two or more contiguous leads, reciprocal ST depression and Q waves). In fact, there are two additional indicators: changes compared with earlier ECGs and changes seen from one new ECG to the next.

Considering the increasing quality of 12-lead AMI diagnostic methods, the value of a pre-arrival alert and the speed with which 12-leads can be performed en route, there's no good reason not to do one when you suspect an AMI.



References

1. Antman EM, Anbe DT, Armstrong PW. ˙ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction.ÓJournal of the American College of Cardiology. 44(3):E1-E211, 2004.
 

2. Slovis C. ˙The Importance of Prehospital ECGs.ÓJEMS(Prehospital 12-Lead Supplement). 31(7):5-6, 2006.


 




Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Patient Care, Cardiac and Circulation, Patient Management, Jems Case of the Month

What's Your Take? Comment Now ...

Buyer's Guide Featured Companies

Featured Careers & Jobs in EMS

Get JEMS in Your Inbox

 

Fire EMS Blogs


Blogger Browser

Today's Featured Posts

 

EMS Airway Clinic

Improving Survival from Cardiac Arrest Using ACD-CPR + ITD

Using active compression-decompression CPR with an ITD has been shown to improve 1-year survival from cardiac arrest by 33%.
More >

Multimedia Thumb

Philadelphia Fire Department Apologizes for Medic’s Jab at Police

Union head calls photos a slap in the face of officers.
Watch It >


Multimedia Thumb

D.C. Fire and EMS Crews Blame New Technology for Patient’s Death

Delayed response blamed on recurring dispatch problems.
Watch It >


Multimedia Thumb

Suspect Steals, Crashes Maryland Ambulance

One killed, others injured in Prince George’s County crash.
Watch It >


Multimedia Thumb

Tennessee Trench Rescue

Worker pulled from Roane County worksite.
More >


Multimedia Thumb

Time’s Ebola Firefighters

Doctors, nurses and others saluted for fighting virus.
More >


Multimedia Thumb

Car Strikes Manhattan Pedestrians

Seven people hurt when car jumps curb.
More >


Multimedia Thumb

Field Bridge Xpress ePCR on iPad, Android, Kindle Fire

Sneak peek of customizable run forms & more.
Watch It >


Multimedia Thumb

Braun Ambulances' EZ Door Forward

Helps to create a safer ambulance module.
Watch It >


Multimedia Thumb

VividTrac offered by Vivid Medical - EMS Today 2013

VividTrac, affordable high performance video intubation device.
Watch It >


More Product Videos >