Be a creature of habit: Develop a routine for thorough patient assessment that works for you and practice it consistently. This can help ensure critical components are not overlooked when those difficult calls strike. Turn that practice into reality, cognitively offload and rely on muscle memory, to help deliver optimal patient care when things get crazy.

3 Reasons to Perform an Early 12-Lead in Suspected Cardiac Ischemia...

1. This will help determine if STEMI is present, which may change your destination, based upon your local destination protocols. (See also: TOTW Early 12 Lead EKGs are Critically Important).
2. A STEMI-positive 12-lead ECG would change the total number of nitroglycerin sprays administered (Max. 3 vs Max. 6 in suspected cardiac ischemia, non-STEMI).
3. If the 12-lead ECG identifies an Inferior STEMI, a 15-lead ECG (or modified 12-lead) is to be performed to rule in or out right ventricular infarct (specifically examining lead V4R). These patients are often preload-dependent, and administration of nitroglycerin may cause significant hypotension. Therefore, administration of nitroglycerin is contraindicated in a patient with a 12-lead ECG compatible with Right Ventricular MI (ST elevation > 1mm in V4R).

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