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7/29/2019 Why12 Leads
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ems12-lead.com
To the presenterPlease click on Notes Pagein the View menu to display thespeakers notes.Thanks,Tim Phalen
Copyright, Tim Phalen, 2001All rights reserved
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Why 12-Leads?
The Benefits of a
Prehospital 12-Lead ECG
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The Benefits of a
Prehospital 12-Lead ECG Recognize AMI
Identify Reperfusion Candidates Early is Better
Reduce Time to Thrombolysis
Reduce Time to PCI Prehospital Thrombolytics
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Case Presentation
46 year old woman
Episode of weakness Patient now feels much better
Vital signs all within normal limits
Lead II shows NSR at 60 BPM
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Case Presentation
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Recognize AMI
Cant just look for chest pain
Atypical presentation are common One third of all AMIs have no chest pain
ED may miss 5% of all AMIs
The 12-lead helps to identify AMI
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Case Presentation
54 year old man
Squeezing, sub-sternal chest pain Constant for 45 minutes
Sudden onset while at rest
Skin cool and moist
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Case Presentation
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Identify Reperfusion
Candidates Classic AMI presentation
Patient was infarcting ECG did not show ST elevation
Immediate reperfusion NOT indicated
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Immediate Reperfusion
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Case Presentation
Chest Pain for 2 hours
4 on a 1-10 scale 12-lead obtained with the first vitals
Oxygen and nitroglycerin given
Next 12-lead eight minutes later
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8
M
IN
U
T
ES
A
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A
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T
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Value of an Early ECG
ECG changes from ACS are dynamic
MONA treatment may mask changes ST elevation = reperfusion indication
EMS is in a priviledged position
Early 12-lead During symptoms
Before medication
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Case Presentation
Male patient with chest pain
Duration less than 2 hours No recent surgery or stroke
No bleeding disorders or trauma
No other obvious contraindicationstoThrombolytics
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Case Presentation
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Reduce Time to
Thrombolysis
Many studies have shown significant
reductions in hospital-based time totreatment with fibrinolytic therapy inpatients with AMI identified before arrivalby 12-lead ECG. Time savings ranged from
20-55 minutes.AHA, Guidelines 2000, page I-172
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Reduce time to PCI
PCI preferred by some facilities
Patients with contraindication tothrombolytic therapy
High-risk patients
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Prehospital Thrombolysis
TIMI-19 and Assent II trials currentlyinvestigating prehospital
thrombolysis
ACEP says
consider if
30 minutes ormore are saved
AHA says
consider if
60 minutes ormore are saved
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The Benefits of a
Prehospital 12-Lead ECG Recognize AMI
Identify Reperfusion Candidates Early is Better
Reduce Time to Thrombolysis
Reduce Time to PCI Prehospital Thrombolytics
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Additional Benefits
Recognize right ventricular infarction
1-2 liter of fluid for hypotension Nitro and MS may induce hypotension
AV block management
Helps distinguish nodal from infranodal Stable wide complex tachycardia
Helps differentiate V-tach from SVT with
aberrant conduction
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For Further Information
ems12-lead.com