To the presenter

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Thanks, Tim Phalen

Copyright, Tim Phalen, 2001 All rights reserved

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Why 12-Leads?
The Benefits of a Prehospital 12-Lead ECG

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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
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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

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Case Presentation

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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

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Case Presentation
54 year old man Squeezing, sub-sternal chest pain Constant for 45 minutes Sudden onset while at rest Skin cool and moist

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Case Presentation

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Identify Reperfusion Candidates

Classic AMI presentation Patient was infarcting ECG did not show ST elevation Immediate reperfusion NOT indicated

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Immediate Reperfusion

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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

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8
M I N U T E S A P A R T
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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
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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 contraindications toThrombolytics
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Case Presentation

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Reduce Time to Thrombolysis

Many studies have shown significant reductions in hospital-based time to treatment with fibrinolytic therapy in patients with AMI identified before arrival by 12-lead ECG. Time savings ranged from 20-55 minutes.
AHA, Guidelines 2000, page I-172

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Reduce time to PCI

PCI preferred by some facilities Patients with contraindication to thrombolytic therapy High-risk patients

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Prehospital Thrombolysis
ACEP says consider if 30 minutes or more are saved AHA says consider if 60 minutes or more are saved

TIMI-19 and Assent II trials currently investigating prehospital thrombolysis

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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
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
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For Further Information

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