Transcription
21 May 2022
Using PI/QI Datato ImproveCV Emergency Outcomes
What Data ?EMS RulesACS FeedbackApplying the Data Clinically
EKG ?
RV Infarct
EMS enroute Code 388 yo F VSSCP x 3 hoursEKG transmittedER Provider ordered IVF Bolus
Post Cath – Mid RCA Stent
V4R ?
ElectrocardiogramRefresherEKG – Electro Cardio Gram
“Plumbing”
“Wiring”
12 Lead Electrode PlacementLimb (Extremity)LeadsRight ArmLeft ArmRight LegLeft LegChest (Precordial) LeadsV1V2V3V4V5V64th Intercostal Space Right Sternal Border4th Intercostal Space Left Sternal BorderBetween V2 And V4Mid–clavicular Line, 5th Intercostal Space5th Intercostal Space, Anterior Axillary Line5th Intercostal Space, Mid-axillary Line
ChestLimb
Limb LeadsExtremity Leads
Chest LeadsPrecordial Leads
EKG Paper1 Small Box 1 mm
STEMIIts All About TheST Segment !!!
STEMI
5 Lead 10 Hz
5 Lead12 Lead 10 Hz
How Much Is Significant 1mm in 2 contiguous leadsMale 40 2 mm in v2-v3 40 yo 2.5 mm in v2-v3Female 1.5 mm in v2-v3
Reciprocal Changes“Opposite” from the site of injury
Reciprocal Changes
STEMI Localization
Symptoms of ACS
Symptoms of ACS
Clinical PearlsIf your patient is sweating, you should be sweating !Atypical is typical“Reflux” is a common symptom for inferior MI and the mostcommon diagnosis for missed MI in litigationThe HPI is the most important factor in predicting ACS“One EKG begets another”Genesis Ch 20 vs 23 – just kidding!“One Troponin begets another”
Clinical PearlsThe HPI is the most important factor in predicting ACSPain radiationDiaphoresisVomitingPain on exertion
Why do 12 lead on scene
Time is Muscle
Why do 12 lead on scene0900 – Respond Chest Pain0900 – Respond Chest Pain0920 – Arrive Scene0920 – Arrive Scene0935 – Transport0925 – EKG1000 – Arrive ED1010 – EKG1015 – Prep TNK1020 – TNK0928 – Notify ED0930 – Prep TNK0935 – Transport1000 – Arrive ED1005 – TNK
Aspirin
Clinical PearlDo not wait for Troponinto treat STEMI
Fibrinolytics 30 MinutesBreaks up the fibrinnetwork that bindsclots together
FMC 90 Minutes
What Data ?EMS RulesACS FeedbackApplying the Data Clinically
12 Lead Electrode Placement Limb (Extremity) Leads Right Arm Left Arm Right Leg Left Leg Chest (Precordial) Leads V1 4th Intercostal Space Right Sternal Border V2 4th Intercostal Space Left Sternal Border V3 Between V2 And V4 V4 Mid-clavicular Line, 5th Intercostal Space V5 5th Intercostal Space, Anterior Axillary Line V6 5th Intercostal Space, Mid-axillary Line
