February 2009 CE

Site Code #107200E-1209

Revisions to the CMC EMS System

CE Program and

Determining ST Elevation on 12-Lead EKG’s

Prepared by: Bill Glade, DC, Wauconda Fire Department Sharon Hopkins, RN, BSN, EMS Educator

Date of CE presentation: February 2009 Topic: Overview of the Revised Condell EMS System CE and Determining ST Elevation on 12 lead EKG’s Behavioral Objectives: Upon successful completion of this module, the EMS provider will be able to: 1. Identify the changes in the Condell EMS System CE program as taught in class. 2. Identify the appropriate components of the cardiac conduction system with the correct wave form on a rhythm strip. 3. Identify when it is appropriate to obtain a 12 lead EKG. 4. Identify the criteria for significant ST elevation following guidelines reviewed in class. 5. Identify EKG leads that view the anterior, inferior, lateral walls, and septum. 6. Recognize the patterns of an MI after viewing the components of a 12 lead EKG. 7. Identify typical and atypical presentations of an acute MI. 8. Identify complications associated with an inferior wall MI. 9. Identify complications associated with an anterior/septal wall MI. 10. Identify complications associated with a lateral wall MI. 11. Identify interventions for the complications of heart block, pulmonary edema, and cardiogenic shock. 12. Identify the SOP guidelines for the patient presenting with acute coronary syndrome as written in the Region X SOP’s. 13. State dosing and precautions for Aspirin, Nitroglycerin, and Morphine. 14. Identify ED staff expectations of EMS personnel when calling the hospital to report a patient with ST elevation identified on a 12 lead EKG. 15. Identify EMS expectations when delivering a patient to a hospital after ST elevation has been identified on a 12 lead EKG. 16. Actively participate in 12 lead EKG scenario practice and discussion. 17.Given a picture, trace the order of the cardiac conduction system correctly. 18. Given a manikin, correctly place electrode placement to obtain a 12 lead EKG.

References:

� Aehlert, B. EKG’s Made Easy third Edition. Elsevier Mosby. 2006. � Beasley, B. Understanding EKG’s A Practical Approach. Brady. 2003. � Bledsoe, B., Porter, R., Cherry, R. Paramedic Care Principles and Practices. Third Edition. Brady.

2009. � Ellis, K. EKG Plain and Simple. Prentice Hall. 2002. � Page, B. 12 Lead EKG for Acute and Critical Care Providers. Brady. 2005. � Phalen, T., Aehlert, B. The 12 Lead EKG in Acute Coronary Syndromes. Second Edition, Elsevier

Mosby. 2006. � Region X SOP’s. March 2007, Amended January 1, 2008. � freemd.com (Acute Coronary Syndrome 9/2008) � www.anaesthetist.com/icu/organs/heart/ecg/Findex.htm � www.ecglibrary.com/ � www.gwc.maricopa.edu/class/bio202/cyberheart/ekgqzr.htm � www.madsci.com/manu/ekg_mi.htm

File: CE, EMS; CE Packets; 2009; Feb 2009 Cardiac CE Dept Obj 7 References ; Revised 2.6.09

Answers and in-depth information for the following 10 cases can be obtained from the accompanying power point program. The power point program is available through your department Medical Officer and via the CMC EMS website at Condell.org/emergency/.

12-Lead Electrode Placement

Contiguous Leads

• Lateral wall: I, aVL, V5, V6

• Inferior wall: II, III, avF

• Septum: V1 and V2

• Anterior wall: V3 and V4

• Posterior wall: V7-V9 (leads placed

on the patient’s back 5th intercostal

space creating a 15 lead EKG)

Practice Identifying ST Segment

Elevation

> 1mm (1 small box) above the baseline in 2 leads from any group or 2 or more contiguous leads

(>2 mm (2 small boxes) in limb leads considered alternative elevation by some) measured 0.04 seconds after J point

Case #1Case #1

52 year-old patient complains of indigestion after pizza & beer dinner.

� VS: 124/82; P – 108; R - 18

� Is there ST elevation:

� I, aVL, V5, V6?

� II, III, aVF?

� V1, V2?

� V3, V4?

� What are you going to do for this patient?

Case #2Case #2

� 62 year-old female developed chest & jaw pain while in the shower

� VS: 110/62; P – 66; R – 20

� Is there ST elevation:

� I, aVL, V5, V6?

� II, III, aVF?

� V1, V2?

� V3, V4?

� What are you going to do for this patient?

Case #3Case #3

� 45 year-old patient who complains of chest heaviness & lightheadedness

� VS: 90/56; P – 86; R - 22

� Is there ST elevation:

� I, aVL, V5, V6?

� II, III, aVF?

� V1, V2?

� V3, V4?

� What are you going to do for this patient?

Case #4Case #4

� 87 year-old female patient complains of dizziness and being extremely tired

� VS: 88/52; P – 30; R - 16

� Is there ST elevation:

� I, aVL, V5, V6?

� II, III, aVF?

� V1, V2?

� V3, V4?

� What are you going to do for this patient?

Case #5Case #5

� 58 year-old male patient who complains of chest pain radiating down the left arm after working out in the gym

� VS: 110/72; P – 100; R - 18

� Is there ST elevation:

� I, aVL, V5, V6?

� II, III, aVF?

� V1, V2?

� V3, V4?

� What are you going to do for this patient?

Case #6Case #6

� 92 year-old patient complaining of pounding in her chest for one hour

� VS: 98/66; P – 110; R- 16

� Is there ST elevation:

� I, aVL, V5, V6?

� II, III, aVF?

� V1, V2?

� V3, V4?

� What are you going to do for this patient?

Case #7Case #7

� 66 year-old patient with history of diabetes for 25 years complains of being lightheaded and is sweaty

� Is there ST elevation:

� I, aVL, V5, V6?

� II, III, aVF?

� V1, V2?

� V3, V4?

� What are you going to do for this patient?

Case #8Case #8

� 70 year-old patient had a syncopal episode when they stood up from the couch

� VS: 156/98; P – 76; R - 16

� Is there ST elevation:

� I, aVL, V5, V6?

� II, III, aVF?

� V1, V2?

� V3, V4?

� What are you going to do for this patient?

Case #9Case #9

� 82 year-old patient complains of sudden onset of slurred speech, inability to grasp a coffee cup, and inability to follow simple commands

� VS: 122/84; P – 110; R - 18

� Is there ST elevation:

� I, aVL, V5, V6?

� II, III, aVF?

� V1, V2?

� V3, V4?

� What are you going to do for this patient?

Case #10Case #10

� 36 year-old patient who passed out standing in line at a bank

� VS: 128/78; P – 80; R - 20

� Is there ST elevation:

� I, aVL, V5, V6?

� II, III, aVF?

� V1, V2?

� V3, V4?

� What are you going to do for this patient?