EMS is one of those fields where you have to be on top of your game at all times! Having a field guide is great, but do you always have time to pull it out of your bag that is never conveniently placed within reach? How about that phone a friend option or that medical control Doc on standby? I believe training your brain to retain new and changing medical sciences is the key to optimum patient care. I plan to post at least weekly some sort of EMS medical quiz/case in an effort to aid in retention and spark an interest in continued education. Lets start off simple, in the comment section below please answer the following cardiac questions.
Name the lead/s of elevation for the following Myocardial Infarctions.
Anterior
Inferior
Posterior
Lateral
Septal
May 30, addition,
Thanks for the replies to the quiz! Time for the answers and a few insightful tips.
Inferior II, III, AVF (RCA)
Anterior v3,v4 (LAD)
Lateral I, AVL, V5,V6 (CIRC)
Septal V1, V2 (LAD)
Posterior (only found by 15 lead). V8,V9 (RCA)
Proper treatment of any MI depends heavily on your ability to recall foundation and understand physiology. Early identification is key and that means getting that ECG ASAP. Not all STEMIs are created equal, each require a different mindset and altered treatment. The right side of the heart reacts much different than the left and often presents with varied signs and symptoms. Inferior MIs rarely present with SOB because there is minimal back flow of fluids to pleural spaces whereas left side often presents with SOB and cyanosis due to ARDS or conditions similar.
On that note, each MI should prompt the medic to determine a course of treatment that best suits the patient. Right sided MIs should be given fluids (2 large bore lines) in an effort to "prime the pump" prior to ANY nitrate or vasodilator administration due to a high potential for hypotension. We all are well aware of the side effect of significant hypotension. Allowing this occurrence also promotes further cardiac cell loss and decreased prognosis for the patient.
Left sided Infarctions (LAD) obstructions often need judicious nitrates and occasionally positive pressure ventilation (severe lesions) due to back flow to pleural spaces. These MIs, if not treated promptly, will lead to a long road of CHF progression.
Our role as EMS providers has become much more than using the "whoop whoops" to get someone to the hospital. We are professional caregivers and patient advocates who should use each opportunity given to benefit each patient. Take pride in your profession and strive to be the best! Take the next available opportunity to attend a 12 lead interpretation and treatment class or consult your local educator. A fathers ability to play with his children vs. watching from the window depends heavily on your dedication to your profession and continued education.
Thanks for your time and I hope this has been helpful and confusion free please feel free to post your comments or requests for future quiz topics.
NEVER STOP ASSESSING!!
