Comments for EMS 12-Lead http://ems12lead.com Advanced airway procedures, cardiac rhythm analysis, 12-lead ECG interpertation, advanced cardiac life support, pharmacology, and special resuscitation situations Tue, 22 May 2012 06:35:22 +0000 hourly 1 http://wordpress.org/?v=3.3.2 Comment on 50 year old male CC: Chest pain by Lizzette Alexandropoul http://ems12lead.com/2011/04/50-year-old-male-cc-chest-pain/comment-page-1/#comment-56160 Lizzette Alexandropoul Tue, 22 May 2012 06:35:22 +0000 http://ems12lead.com/?p=4294#comment-56160 Apart from the primary software, you will get crammed music creation lessons in nearly every aspects of audio generating identical to the ProTools, Logic, keyboards, software instruments and much more. On this whole music manufacturing suite, you are going to have employment to realize knowledge employing only various sorts of instruments to produce music and beats easily. Included as well are fantastic quality instrumentals and beats that will help you creating tracks on sonic producer with no trouble. Apart from the primary software, you will get crammed music creation lessons in nearly every aspects of audio generating identical to the ProTools, Logic, keyboards, software instruments and much more. On this whole music manufacturing suite, you are going to have employment to realize knowledge employing only various sorts of instruments to produce music and beats easily. Included as well are fantastic quality instrumentals and beats that will help you creating tracks on sonic producer with no trouble.

]]> Comment on Snapshot Discussion: 32 year old Male–Chest Discomfort by K.I.S.S. http://ems12lead.com/2012/05/snapshot-discussion-32-year-old-male-chest-discomfort/comment-page-1/#comment-55869 K.I.S.S. Sun, 20 May 2012 23:25:55 +0000 http://ems12lead.com/?p=6361#comment-55869 I think we all tend to overcomplicate these wide complex tachs: Assume VT until we get a baseline EKG proving an aberrancy. Procainimide if stable (warm extremities + SBP nml for that patient). Electricity if unstable (cool extremities or SBP < nml for that patient).   I think we all tend to overcomplicate these wide complex tachs: Assume VT until we get a baseline EKG proving an aberrancy. Procainimide if stable (warm extremities + SBP nml for that patient). Electricity if unstable (cool extremities or SBP < nml for that patient).
 

]]> Comment on Snapshot Discussion: 32 year old Male–Chest Discomfort by Danny http://ems12lead.com/2012/05/snapshot-discussion-32-year-old-male-chest-discomfort/comment-page-1/#comment-55810 Danny Sun, 20 May 2012 18:10:52 +0000 http://ems12lead.com/?p=6361#comment-55810 All of these treatments are generally standing orders though. You have a young patient with a wide and fast 12lead, at a rate of over 260. VT or not, if you do not attempt to treat this, it will be brought to someone's attention at some point in the review process.  Based on that mindset, an ALS ambulance should simply stock fluids. You do not know that this patient will remain "stable" during transport. Better to be a little ahead than to have to play catchup. Just my thinking. All of these treatments are generally standing orders though. You have a young patient with a wide and fast 12lead, at a rate of over 260. VT or not, if you do not attempt to treat this, it will be brought to someone's attention at some point in the review process.  Based on that mindset, an ALS ambulance should simply stock fluids. You do not know that this patient will remain "stable" during transport. Better to be a little ahead than to have to play catchup. Just my thinking.

]]> Comment on Treat the patient not the monitor? by Danny http://ems12lead.com/2012/05/treat-the-patient-not-the-monitor/comment-page-1/#comment-55809 Danny Sun, 20 May 2012 18:00:56 +0000 http://ems12lead.com/?p=6377#comment-55809 Great post. I agree... EKG interpretation IS tough, and I think many people who fall back to saying "how about we treat the patient, not the monitor" simply do not know what is on the monitor!  In the grand scheme of things, I know very little about EKGs, but I am trying to learn as much as I can everyday. Thanks for this website! Great post. I agree… EKG interpretation IS tough, and I think many people who fall back to saying "how about we treat the patient, not the monitor" simply do not know what is on the monitor!  In the grand scheme of things, I know very little about EKGs, but I am trying to learn as much as I can everyday. Thanks for this website!

]]> Comment on Data quality, lead placement, your patient’s dignity, and undressing female patients by Tom Bouthillet http://ems12lead.com/2009/06/data-quality-lead-placement-your-patients-dignity-and-undressing-female-patients/comment-page-1/#comment-55615 Tom Bouthillet Sat, 19 May 2012 21:48:30 +0000 http://ems12lead.com/2009/06/01/data-quality-lead-placement-your-patients-dignity-and-undressing-female-patients/#comment-55615 <p>You cannot perform a 12-lead ECG with accurate electrode placement without removing (or at least unsnapping) the bra because the bra literally covers up the anatomical positions for leads V1, V2 and V3. On occasion I have left the cups over the breasts but had the patient remove her arms from the straps. But what's the difference between that and having the patient remove her bra and covering her up with a towel or sheet? This insinuation that I'm doing something wrong or unethical, or that I'm not really really obtaining the patient's consent is ridiculous, and like Christopher and David we carry gowns on the ambulance. I believe in risk management but not to the point of being paranoid about appropriate patient care. BTW the above post from Star of Life Law is from a paramedic who works in my service. He wrote about this issue here: <a href="http://staroflifelaw.com/2009/06/09/exposing-patients-balancing-necessity-and-dignity/" rel="nofollow">http://staroflifelaw.com/2009/06/09/exposing-patients-balancing-necessity-and-dignity/</a></p> You cannot perform a 12-lead ECG with accurate electrode placement without removing (or at least unsnapping) the bra because the bra literally covers up the anatomical positions for leads V1, V2 and V3. On occasion I have left the cups over the breasts but had the patient remove her arms from the straps. But what's the difference between that and having the patient remove her bra and covering her up with a towel or sheet? This insinuation that I'm doing something wrong or unethical, or that I'm not really really obtaining the patient's consent is ridiculous, and like Christopher and David we carry gowns on the ambulance. I believe in risk management but not to the point of being paranoid about appropriate patient care. BTW the above post from Star of Life Law is from a paramedic who works in my service. He wrote about this issue here: http://staroflifelaw.com/2009/06/09/exposing-patients-balancing-necessity-and-dignity/

]]> Comment on Treat the patient not the monitor? by K. Garner http://ems12lead.com/2012/05/treat-the-patient-not-the-monitor/comment-page-1/#comment-55583 K. Garner Sat, 19 May 2012 18:48:13 +0000 http://ems12lead.com/?p=6377#comment-55583 I love the articles and comments and the wonderful learning oppertunity afforded by your site. When I was in class the statement usually referred to a patient that was either completely asymptomatic despite monitor findings ie. bradycardic but no pain or confusion or low blood pressure; or very symptomatic with normal EKG findings ie. diaphoretic, extreme chest discomfort, or feeling of impending doom with no changes evident on EKG. In these situations one tends to be better served by treating the patient and not the monitor. The end take home is to pull all of the information together, EKG, SPO2, vitals, history, and physical presentation then arrive at the appropriate diagnosis and treat appropriately. I love the articles and comments and the wonderful learning oppertunity afforded by your site. When I was in class the statement usually referred to a patient that was either completely asymptomatic despite monitor findings ie. bradycardic but no pain or confusion or low blood pressure; or very symptomatic with normal EKG findings ie. diaphoretic, extreme chest discomfort, or feeling of impending doom with no changes evident on EKG. In these situations one tends to be better served by treating the patient and not the monitor. The end take home is to pull all of the information together, EKG, SPO2, vitals, history, and physical presentation then arrive at the appropriate diagnosis and treat appropriately.

]]> Comment on Treat the patient not the monitor? by Ken Grauer http://ems12lead.com/2012/05/treat-the-patient-not-the-monitor/comment-page-1/#comment-55575 Ken Grauer Sat, 19 May 2012 17:12:30 +0000 http://ems12lead.com/?p=6377#comment-55575 <em><strong>Excellent post</strong></em> by Dave with true words of wisdom! By way of illustrating when teaching ECGs - I often show tracings such as the one on my <a href="http://ecg-interpretation.blogspot.com/2010/12/ecg-interpretation-review-2-st-segment.html" rel="nofollow"><strong>ECG Blog #2</strong></a> - for which the Clinical Impression (<em>and appropriate intervention</em>) depends dramatically on the clinical setting - even though Descriptive Analysis of this tracing (<em>diffuse ST elevation</em>) doesn't change. I think it wonderful to expand the philosophy expressed by Dave in this post to the EMS community. P.S. Perhaps an even better way to say it is, <em>"Treat the patient IN THE CONTEXT OF the monitor"</em>. By "treating the patient" - what really is implied is "the whole patient" (<em>with presumption to the thinking clinician that this DOES include the rhythm on the monitor/ECG as well as what the patient 'looks like'</em> ). To ensure optimal thinking by clinicians - perhaps spelling it out by adding <em>"in the context"</em> may help. THANKS again Dave for an excellent post! Excellent post by Dave with true words of wisdom! By way of illustrating when teaching ECGs – I often show tracings such as the one on my ECG Blog #2 – for which the Clinical Impression (and appropriate intervention) depends dramatically on the clinical setting – even though Descriptive Analysis of this tracing (diffuse ST elevation) doesn't change.

I think it wonderful to expand the philosophy expressed by Dave in this post to the EMS community.

P.S. Perhaps an even better way to say it is, "Treat the patient IN THE CONTEXT OF the monitor". By "treating the patient" – what really is implied is "the whole patient" (with presumption to the thinking clinician that this DOES include the rhythm on the monitor/ECG as well as what the patient 'looks like' ). To ensure optimal thinking by clinicians – perhaps spelling it out by adding "in the context" may help. THANKS again Dave for an excellent post!

]]> Comment on Treat the patient not the monitor? by Kyle Norris http://ems12lead.com/2012/05/treat-the-patient-not-the-monitor/comment-page-1/#comment-55570 Kyle Norris Sat, 19 May 2012 16:59:44 +0000 http://ems12lead.com/?p=6377#comment-55570 Thank you sincerely. I've been saying for years this very thing. If I'm going to ignore what the monitor is telling me, why do I lug around 20 extra pounds of kit? If the monitor and what you see on exam don't match, you have to investigate WHY. It may be a false monitor reading, it may also be your exam missed something. What the phrase means to me is "my instructor didn't know how to correlate and sort through information, so he taught me yet another EMS proverb that overly simplifies things". Thank you sincerely. I’ve been saying for years this very thing. If I’m going to ignore what the monitor is telling me, why do I lug around 20 extra pounds of kit?

If the monitor and what you see on exam don’t match, you have to investigate WHY. It may be a false monitor reading, it may also be your exam
missed something.

What the phrase means to me is “my instructor didn’t know how to correlate and sort through information, so he taught me yet another EMS proverb that overly simplifies things”.

]]> Comment on Treat the patient not the monitor? by Nick Adams http://ems12lead.com/2012/05/treat-the-patient-not-the-monitor/comment-page-1/#comment-55566 Nick Adams Sat, 19 May 2012 16:32:32 +0000 http://ems12lead.com/?p=6377#comment-55566 Very good article.  I've always said to treat the patient AND the monitor.  The monitor is just one more assessment tool that we can use prehospitally to come to a reasonable conclusion as to what is going on with our patient, so we can appropriately treat thier needs. It should never be ignored or dismissed as something that is not important because the pt is doing ok at this time.  They may not be doing ok one minute from now.  The monitor may also cause to you alter your treatment descisions based on your interpretation of the rhythm, such as seeing delta waves or bifascicular blocks based on QRS axis (RBBB w/LAFB).  Personally, I don't give anyone medication unless they're on a monitor.  I can see if the medication I am giving is working, or a sudden onset of tachycardia may be the first indication that my patient is having an allergic reaction to the medication I just gave.  The monitor has many uses other then rate and rhythm. Very good article.  I've always said to treat the patient AND the monitor.  The monitor is just one more assessment tool that we can use prehospitally to come to a reasonable conclusion as to what is going on with our patient, so we can appropriately treat thier needs. It should never be ignored or dismissed as something that is not important because the pt is doing ok at this time.  They may not be doing ok one minute from now.  The monitor may also cause to you alter your treatment descisions based on your interpretation of the rhythm, such as seeing delta waves or bifascicular blocks based on QRS axis (RBBB w/LAFB).  Personally, I don't give anyone medication unless they're on a monitor.  I can see if the medication I am giving is working, or a sudden onset of tachycardia may be the first indication that my patient is having an allergic reaction to the medication I just gave.  The monitor has many uses other then rate and rhythm.

]]> Comment on Treat the patient not the monitor? by Adrienne Linn http://ems12lead.com/2012/05/treat-the-patient-not-the-monitor/comment-page-1/#comment-55555 Adrienne Linn Sat, 19 May 2012 15:48:04 +0000 http://ems12lead.com/?p=6377#comment-55555 Thank you for saying what I'be been thinking. Every time we play the treat the patient and not the monitor game, whether it is the 12lead, capnography, pulse ox or even the glucometer. We are also ignoring valuable info the can help up treat the patient appropriately. Our docs use lab values, xrays, CTs, MRIs and the tools we have to help them make a diagnosis. Why are we acting like we are better that they and don't need any tools but our stethoscopes and eyes to figure out what is going on and treat it. Our ignorance as a community is killing our profession and losing us ground in our scopes of practice. As one of my attending docs told me a couple days ago, protocols are written based on the abilities of the lower third of the cohort, not the upper third. Treating the patient using the monitor and all available tools, using sound clinical judgement and constantly striving to better our education will serve our patients and our community much better than ignorant arrogance. Thank you for saying what I'be been thinking. Every time we play the treat the patient and not the monitor game, whether it is the 12lead, capnography, pulse ox or even the glucometer. We are also ignoring valuable info the can help up treat the patient appropriately. Our docs use lab values, xrays, CTs, MRIs and the tools we have to help them make a diagnosis. Why are we acting like we are better that they and don't need any tools but our stethoscopes and eyes to figure out what is going on and treat it. Our ignorance as a community is killing our profession and losing us ground in our scopes of practice. As one of my attending docs told me a couple days ago, protocols are written based on the abilities of the lower third of the cohort, not the upper third. Treating the patient using the monitor and all available tools, using sound clinical judgement and constantly striving to better our education will serve our patients and our community much better than ignorant arrogance.

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