What Makes You Run A 12 Lead?

[musicemt]

Now that I'm done with the didactic portion of my medic class and getting ready to start ride time, there's been a couple of questions that popped in my head in terms of channeling book knowledge into street sense. It stands to reason that you run a 12 lead on a patient with chest pain; I used to work for a large urban 911 service that called themselves very aggresive on 12 leads; they ran them on every person with chest pain, and that's about it. I know that there are atypical presentations of MI, and some situations where a 12 lead is useful for differant purposes than looking for ST changes.

So my question is this; what complaints other than chest pain would prompt you to run a 12 lead? Anybody have any general guidelines to go by?

[TheGooseMedic]

SOB, dizziness, syncope, general weakness, CVA's. I do quite a few 12 leads. Those are the ones that pop into my mind.

[Lord_Balsac]

^ What he said...

also epigastric pain, some ABD pain, and some dysrhythmias...

[paramortis]

Women and diabetics tend to present with abnormal signs like back pain.

[jozak78]

Women and diabetics tend to present with abnormal signs like back pain.

don't forget nausea/vomiting

you can run a 12-lead on almost anything really, i'd say it might be a little overkill on some low energy isolated trauma broken arms and such, but then again it's hard to run a 12 on a lot of really bad traumas with so much going on.

[RichmondMedik]

Women and diabetics tend to present with abnormal signs like back pain.

got a call one day for a lady with big toe pain - got to her apt and she looked like death warmed over - I asked if she ever felt this pain before and her reply was " yes, last time I had a heart attack"

so you never know what the presentation could be in the elderly and diabetics

[medic32]

Heres my two cents worth on 12 leads lol. Chest/epigastric pain is obvious, however I also do them all diff breathing, syncope, general illness, weakness, poss CVA and AMS not related to BGL or trauma. Some may call it overkill and thats okay however I treat all patients above as a cardiac in origin until proven otherwise ie IV, O2, monitor and of course 12 lead.

[FF/EMTP1317]

Our medical director likes us to run a 12-lead on all diabetics (if we're transporting). Other than that I am most likely to do them on elderly females that c/o nausea, vomiting, dizziness, back pain. Not that the 12-lead will always show any abnormality but at least you have a baseline.

[MedicPat]

I run them alot, same cases as most have mentioned.

I don't even know why I bother cuz the ED just throws them away and does their own.... I guess we're just glorified taxi drivers to them.

[strwblue]

Anytime the mood strikes the medic in incharge of the Patient?

[TheGooseMedic]

I run them alot, same cases as most have mentioned.

I don't even know why I bother cuz the ED just throws them away and does their own.... I guess we're just glorified taxi drivers to them.

Where I work, the ED still does there own, but that is to look for changes since I did my 12 lead and then they compare the two. Years ago they just threw them away though. :)

[jdemaio]

Where I work, the ED still does there own, but that is to look for changes since I did my 12 lead and then they compare the two. Years ago they just threw them away though. :)
Yeah, your initial 12 lead can be used to look for changes.

[kjrff23]

Chest trauma, any metabolic issues that may cause arrythmias, severe difficulty breathing that is causing secondary cardiac symptoms. Our monitors are set up for Lead II, III, and aVF, if anything looks funky in any one of those leads it gets a 12 lead.

[musicemt]

Just finished up a run that made me a big believer in serial 12-leads. Transferred out of the ER a patient c/o c/p and SOA, relieved with 60 of lasix (2100 cc output). Set up initial 12 lead and reran them all the way in (30 min tx). Saw a notched QRS pop up in V1 with a transient RAD, and based on those findings the folks at the receiving facility prepped the guy for immediate PCI.

Guess this tuff really DOES make a differance after all!

[tom10406]

By rules

chest pain
dizzyness
syncope
females with atypical chest pain

I do them on seizure calls, or when ever I get the urge. The seizure idea came in after I had my seizure. The inital 12 lead showed an inverted T and the follow up and stress tests showed I was fine. My partner and I got a call for a 15 yo male having seizures. The mom told us that this was his 3 seizure and they had no diagnosed cause, he was waiting for an MRI. She had also told us he gets dizzy with exertion. He was a tall, skinny kid, pale. All this normal.
The mom decided that she didn't want to start him on the anti seizure meds yet, until they had a cause. I ran a 12 lead, the QRS looked OK, the print at the top of the strip, showed "abnormal ECG, poss ventricular enlargement". The mom said that he did have an echocardigram done the day before and were waiting on results. When we relayed this to the ER their 12 lead showed the same as ours. They got a hold of the ech results and it showed an ejection fraction of <40%. Possibly that could be the cause of the seizures.

[mmorsepfd]

I run them alot, same cases as most have mentioned.

I don't even know why I bother cuz the ED just throws them away and does their own.... I guess we're just glorified taxi drivers to them.

The more you do the 12 leads the more the ER listens. The first couple of times I brought a patient in with a 12 lead I was pretty much ignored, now the triage people know what to expect and trust our work. I do the 12 lead prior to treatment if practical, 02 and nitro work fast and can mask ecg abnormalities. My criteria for a 12-lead is usually based on patient appearance along with complaints. Some people c/o cp just don't have "that look."

[jeffery.boyd]

I work in a rural area. Let me explain that. County EMS system with 10,000 people and two ambulances both ALS capable running LP 12's. There is no hospital in my county. Nearest is 28 miles and that is NOT a Medical Center. 54 Miles to Trauma/CVA/Heart center.

I have so much time I look at is as when do I NOT perform a 12 lead. My thought is Altered LOC, CP, SOB, Seizure, Hyper/Hypo tension, not feeling well etc all gets one because my transport time is routinely 30-40 minutes to PODUNK hospital to 1 hr to big city medicine. Still using the big paper vs old school LP5/10 size paper. Might as well obtain it is my thought.

[vudumedic]

When I have a patient that has any risks for a cardiac problem. So when I am transporting a patient. Had one lol who had hip pain and no trauma of any kind just couldn't sleep because of hip pain (lil' 'ole lady)

[CombatMedic]

In all honesty

THE PAGER

[fishy]

As a rule CP, diff breathing, palpitations, epigastric pain, disrhythmias and then in pts where the 4-lead shows something funky, I'll connect the rest aswell just to be sure.

[pdxmedic]

A lot of people have posted good indications for 12 leads. A good one that I think often gets forgotten is the post-cardiac arrest patient. Anyone who we get a perfusing rhythm on gets a 12 lead during transport. I've had pts with big STEMIs who coded again at the hospital, and in at least once case our 12 lead (showing a huge STEMI) was important in both getting the cath lab spun up and also influencing the aggressiveness of resuscitation.

Any kind of syncope or near-syncopal episode definitely gets a 12. I didn't do one once on a mid-50s woman who'd had a near-syncope 14 hours before and been "shaky" since -- "but I feel like this all the time, it's just worse today." We were very close to the hospital and I decided not to do one. Big STEMI. Oh well. She had a good outcome and it wasn't a problem, but it was a wake-up call to me.

They can also be helpful in diagnosing the more unusual dysrhythmias (afib with RVR and a LBBB is a fun time)...

[Philly Medic]

As a rule CP, diff breathing, palpitations, epigastric pain, disrhythmias and then in pts where the 4-lead shows something funky, I'll connect the rest aswell just to be sure.

Can't go wrong with that. Don't rule out young people either. Had 22 yo female pre-12 lead who just felt sick. Pulse ox showed rate of 178 place on the old reliable LP-10 had a little SVT going. Responded to adenosine. Maybe a 12-lead pre adenosine might have helped cardiologist.

[WEMT-I312]

Maybe think of it as "What Makes You NOT Run A 12 Lead"? It's not invasive, and as long as you stay on point in your assessments, a 12 Lead won't negatively impact your patient.

[tom10406]

By standing order, we have to with chest pain, sob, syncope, elderly with abdominal pain (the a tipical MI type). I do it for blunt chest trauma, post hypoglycemics (after we treat them). I also do it for seizures. The reason is, I had one a couple of years ago, and my first 12 lead showed inverted T waves, the follow up showed things were fine. I had a 13 yo with a seizure. It was his 3rd with no set diagnosis as of yet. He was being investigated by a neurologist and was to see a cardiologist. I ran a 12 lead on him and it showed ventricular hypertrophy. After I showed the 12 lead to the ER doctor, he ordered an echocardio gram and it showed an decreased ejection fraction. When I followed up, he was clear neuro wise and they figured that it was the ejection fraction, was causing some hypoxia, giving the seizures.

[Paragod689]

Your place of employment should have a list 12 lead indications. Atleast I believe most do?

[musicemt]

Mine does, but it vaguely lists "anginal equivelants" along with suspected-cardiac etiology chest pain. The main rule I've come to adopt is that any time it would be prudent to know how the heart is functioning, try a 12 lead. I'm starting to see in the field that looking for BBBs, axis deviation, and hypertrophy can be just as revealing as ST elevation. Thanks to all for replying, definitely been eye-opening for a new medic!

[gangstamedic]

we pretty much do one on every one, no exceptions unless it is a clear cut BLS call

[GaHazMedic]

we pretty much do one on every one, no exceptions unless it is a clear cut BLS call

That's a little bit of overkill. Hell, even the hospitals don't do that.

[fishy]

That's a little bit of overkill. Hell, even the hospitals don't do that.

They do here. Every medical (as in, non-surgical) patient that gets admitted get a 12-lead and bloodwork done at the ER. Surgical patients only get one, if they're going to the OR.

[Medic_QT]

They do here. Every medical (as in, non-surgical) patient that gets admitted get a 12-lead and bloodwork done at the ER. Surgical patients only get one, if they're going to the OR.

Same policy at my ER.