7/29/2019 Why12 Leads

1/21

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

7/29/2019 Why12 Leads

2/21

ems12-lead.com

Why 12-Leads?

The Benefits of a

Prehospital 12-Lead ECG

7/29/2019 Why12 Leads

3/21

ems12-lead.com

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

7/29/2019 Why12 Leads

4/21

ems12-lead.com

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

7/29/2019 Why12 Leads

5/21

ems12-lead.com

Case Presentation

7/29/2019 Why12 Leads

6/21

ems12-lead.com

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

7/29/2019 Why12 Leads

7/21

ems12-lead.com

Case Presentation

54 year old man

Squeezing, sub-sternal chest pain Constant for 45 minutes

Sudden onset while at rest

Skin cool and moist

7/29/2019 Why12 Leads

8/21

ems12-lead.com

Case Presentation

7/29/2019 Why12 Leads

9/21

ems12-lead.com

Identify Reperfusion

Candidates Classic AMI presentation

Patient was infarcting ECG did not show ST elevation

Immediate reperfusion NOT indicated

7/29/2019 Why12 Leads

10/21

ems12-lead.com

Immediate Reperfusion

7/29/2019 Why12 Leads

11/21

ems12-lead.com

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

7/29/2019 Why12 Leads

12/21

ems12-lead.com

8

M

IN

U

T

ES

A

P

A

R

T

7/29/2019 Why12 Leads

13/21

ems12-lead.com

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

7/29/2019 Why12 Leads

14/21

ems12-lead.com

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

7/29/2019 Why12 Leads

15/21

ems12-lead.com

Case Presentation

7/29/2019 Why12 Leads

16/21

ems12-lead.com

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

7/29/2019 Why12 Leads

17/21

ems12-lead.com

Reduce time to PCI

PCI preferred by some facilities

Patients with contraindication tothrombolytic therapy

High-risk patients

7/29/2019 Why12 Leads

18/21

ems12-lead.com

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

7/29/2019 Why12 Leads

19/21

ems12-lead.com

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

7/29/2019 Why12 Leads

20/21

ems12-lead.com

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

7/29/2019 Why12 Leads

21/21

ems12-lead.com

For Further Information

ems12-lead.com