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This is why we do bedside 12 leads before rendering treatment

by on August 9, 2011

Called to house of 66 year old male patient with no significant medical history other then high blood pressure. He was outside cutting his grass. The outside temperature was 98 with heat index of 104 degrees. He experienced left side chest pain that radiated down his left arm. Pain is 10/10. He denies shortness of breath but does state nausea with vomiting. Upon exam it is noted that he is pale and clammy. He tells EMS that the pain has been constant for approximately one hour. He originally thought maybe he had indigestion because he was burping some but since it has been going on for so long his wife wants him to go to the ER.

12 lead is obtained

He was placed on 02, ASA 324mg given PO and NTG spray given SL. Moved to stair chair and carried outside and placed on the cot and moved into the unit.

Another 12 lead obtained 10 minutes after the first one was taken

A huge difference. I am a big advocate of obtaining the first 12 lead as soon as possible before giving treatment, as long as it is not detrimental to the patient, so we can have a baseline to go by

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From → Case File, Education

6 Comments
  1. dr. smith had an interesting post not long ago about getting that first 12-lead before ANY treatment because sometimes when the changes normalize after treatment and there is no first 12-lead pre-treatment, the decision to go to the cath lab can become very difficult.

  2. I do recall reading that post from Dr. Smith. I know of a lot of medics that do not believe that getting a base line 12 lead is important.

  3. If it weren’t for III and aVF in the second 12-Lead you’d almost never know anything was wrong!

  4. Dan permalink

    “A huge difference. I am a big advocate of obtaining the first 12 lead as soon as possible before giving treatment, as long as it is not detrimental to the patient, so we can have a baseline to go by”

    I completely agree, and I’d even go so far as to suggest that NOT getting a 12-lead would be detrimental – the case above highlights this well – in my region for instance the initial 12-lead would be direct PPCI lab entry. The second however, would probably spend some time in the ED until the staff decided what was the best course of action.
    How would one know which treatment route to pursue if you don’t have all the information to make an informed decision? I’m all for serial 12-leads prior and post treatments.
    I enjoy these blogs/posts/websites a lot, and continue to learn with every case.
    Thanks

  5. Thank you Dan, I appreciate you visiting and participating.

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