PArescueEMT
Forum Bartender
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So... basically... you're a Jersey medic?
12 Lead EKG?
- Thread starter MMiz
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rescuecpt
Community Leader Emeritus
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Ok, YOU can do a few more things, but the vollie medics I ride with can't...
And I have noted in other places how much HARDER you guys work in school and here I noted how much LONGER you spend in school.
Oh, I did forget to mention though that you are so much smarter than any CC I have ever met, myself included, and that I cry myself to sleep at night because I'm not you.
shorthairedpunk
Forum Lieutenant
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We run 12 leads, its frustrating because we are only trained in interpretation as far as reading what the algorythyum says is happenning. But the LP12s we use are known for reliable interpretations and in the field, spending much more time trying to further interpret on your own is a wate of time for the majority. We can treat based on what the LP12 says. Our Basics are trained to det them up. We have telemetry in the works, but we have to get the hospital to get heir end up and running before we purchase the transmitters.
On the agenda for the BLS units is 12 lead capability if their is time before we intercept with them. LP12s or Zolls are required for any transporting agency in the system, the BLS units will be locked into AED mode though, unless they have the monitor going. They wont have any manual capabilities
On the agenda for the BLS units is 12 lead capability if their is time before we intercept with them. LP12s or Zolls are required for any transporting agency in the system, the BLS units will be locked into AED mode though, unless they have the monitor going. They wont have any manual capabilities
We have been utilizing 12-lead EKG's in our EMS system for about 15 years now and at first they even let us trial the use of some anti-thrombolytics but in the end with there seemingly being a cath lab sprouting up everywhere around us we aren't carrying the pharmacologics anymore. Our protocol is as follows: Any hemodynamically stable patient c/o chest pain that's cardiac in nature (no, the chest vs. steering wheel MVC doesn't count) gets a 12-lead. If transport time is longer than 10 minutes on the unstable patient and everything else is done a 12-lead can be performed en route to the hospital. We then fax the 12-lead via cell phone to the ER for a heads-up so they can ready the cath lab.
Regarding the interpretation of the 12-lead. Here's my personal spin on it And this is what I teach as well. If you can just learn to recognize the presence of ST segment elevation in the contiguous leads that should get you a good start. As far as knowing what MI is occurring where I use the acronym ISAL which stands for the 4 different major AMI's. I (Inferior) S (Septal) A (Anterior) L (Lateral)
The reason I put it in that order is for ease of interpretation of the 12-lead as you are reading it left to right.
It works like this.
I = ST elevation in Leads II, III, and AVF
S = ST elevation in V1 & V2
A = ST elevation in V3 & V4
L = ST elevation in V5 & V6
And that's it.
Until the EMS Medical directors actually decide to write specific protocols based on the type of Infarction the patient is experiencing I don't believe we should have to be super concerned about it either. Just my .02 worth.
Regarding the interpretation of the 12-lead. Here's my personal spin on it And this is what I teach as well. If you can just learn to recognize the presence of ST segment elevation in the contiguous leads that should get you a good start. As far as knowing what MI is occurring where I use the acronym ISAL which stands for the 4 different major AMI's. I (Inferior) S (Septal) A (Anterior) L (Lateral)
The reason I put it in that order is for ease of interpretation of the 12-lead as you are reading it left to right.
It works like this.
I = ST elevation in Leads II, III, and AVF
S = ST elevation in V1 & V2
A = ST elevation in V3 & V4
L = ST elevation in V5 & V6
And that's it.
Until the EMS Medical directors actually decide to write specific protocols based on the type of Infarction the patient is experiencing I don't believe we should have to be super concerned about it either. Just my .02 worth.
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Awsome. I just started at my clinical site, which is just starting to play with 12 leads (telemetry tranmission is on the horizon). 12 lead class was over a year ago, and I've been being babied by the MAC5000's in the ED...
Jon
Jon
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I dissagree...
How can you be certain they aren't having a massive MI either before the accident, or as result of stress and anxiety related to the accident?
A great medic once told me to never rule out chest pain, just because they were in an accident. Too often we look for simple excuse for our problems.
Jon
~ P.S. I'm not attacking you, just illistrating a different point of view.
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I dissagree...
How can you be certain they aren't having a massive MI either before the accident, or as result of stress and anxiety related to the accident?
A great medic once told me to never rule out chest pain, just because they were in an accident. Too often we look for simple excuse for our problems.
Jon
~ P.S. I'm not attacking you, just illistrating a different point of view. [/b][/quote]
Very true, but our protocols specifically state we don't work a "trauma code". We're allowed to do CPR on them and that's it.
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Very true, but our protocols specifically state we don't work a "trauma code". We're allowed to do CPR on them and that's it.
[/b][/quote]Not saying code... just talking about the 35 or 40 y/o male who just wrapped his sports car around a tree who wasn't wearing a seatbelt.
And using Chest Pain as a nature to get the medic to come out and play means no one says you are a wimp for not grounding the guy to the local ED...
Jon
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But the problem I'm seeing with our newer EMT's is that they won't treat the chest pain as cardiac in nature, or if the patient has coded, work him up because of the misunderstanding they have about the protocols.
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Are you saying they won't call ALS for Chest Pain + MVC
And / or
Are you saying they will work the trauma code?
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Are you saying they won't call ALS for Chest Pain + MVC
And / or
Are you saying they will work the trauma code? [/b][/quote]
Yes, they won't call
and/or
No, they won't work it.
I did a scenario a few months back. I gave them a 45yoM, single vehicle MVA at low speeds with no intrusion or significant damage to the vehicle. Pt. was unresponsive and not breathing with no signs of injury. They looked at me and said, "We don't do trauma codes." and refused to work him.
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Yes, they won't call
and/or
No, they won't work it.
I did a scenario a few months back. I gave them a 45yoM, single vehicle MVA at low speeds with no intrusion or significant damage to the vehicle. Pt. was unresponsive and not breathing with no signs of injury. They looked at me and said, "We don't do trauma codes." and refused to work him. [/b][/quote]
Ahhh.
My personal feeling is that if you even suspect the code wasn't caused by tramatic injury, you work them until command says otherwise. What is the worst that could happen? Yu get practice working a code, get a tube, etc, and then have the doc call it. Not a WHOLE TOTAL LOSS!
I'm seeing things like a student, aren't I????
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We had one in my area a while back.
Guy driving down highway with his wife. He starts complaining of chest pain, passes out, drives across the median, strikes a tractor-trailer, tractor trailer looses contro, runs up an embankment and flips back onto the highway. Driver DOA, passenger flown to trauma Center (think she survived, not 100% sure), tractor trailer extrication took 2+ hours. Hazmat playing with driver's cargo for HOURS, road closed for a day.
Jon
Guy driving down highway with his wife. He starts complaining of chest pain, passes out, drives across the median, strikes a tractor-trailer, tractor trailer looses contro, runs up an embankment and flips back onto the highway. Driver DOA, passenger flown to trauma Center (think she survived, not 100% sure), tractor trailer extrication took 2+ hours. Hazmat playing with driver's cargo for HOURS, road closed for a day.
Jon
rescuecpt
Community Leader Emeritus
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We had a firefighter of ours have a heart attack and drive off a cliff down the street from the firehouse. His granddaughter got out with just scratches, his wife was DOA, and he was so badly injured he was unrecognizable. They waited to bury his wife for 3 weeks so that they could be buried together. Amazingly, he has made a full recovery.
I have never seen a LP 5 that could be set up for that...There is no software on that machine...it is a simple crt and a monitor. IIFC :huh:
<!--QuoteBegin-rescuecpt
No, CC and P are the same except for 3 things:
1. P's get paid more
2. P's are in school longer
3. P's can do a needle crych (sp?) CC's cant... YET.
Otherwise everything is the same, P's have a few more standing orders but in the end we have the same skills and the same overall orders. [/quote]
I am not feeling the love here Erika... <_<
Did Medic03 throw you a beatin for this?!?!?
PS it is needle cric (as in Cricothyroidotomy) and do not forget we can do Needle Decompression...it was w/o a 34 when I was there.
They didn't change the ALS protocols did they? EMT-P's standings were more inclusive than the A3's IIRC...but that was a loooooooooooow blow miss! <_<
They really need to allow the poster to edit the post indefinately here!
rescuecpt
Community Leader Emeritus
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I do not deny that CC's know what to do, while P's know WHY to do it. That is the major distinction.
I can do needle decompression w/a 34. They've upgraded protocols a lot. EMT-P's have more standing orders than I do, but in theory, with a phone call, I can do pretty much everything. Gimme your fax #, i'll fax you a copy. :lol:
rescuecpt
Community Leader Emeritus
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