Date Published

February 26, 2020

Updated For

ALS PCS Version 5.2


Early 12-Lead ECG acquisition for all patients with signs and symptoms of Acute Coronary Syndrome (ACS) is critically important to patient outcomes.

Why do we do this? Because we effect change… Ischemic findings on ECG are dynamic. The drugs we give to restore to the balance between myocardial oxygen supply-and-demand can lead to changes and even erase the ischemic signs on the 12-Lead. If a patient’s STEMI is not captured, it cannot be acted upon! Note also that repeat 12-Leads, with change in patient condition, can be beneficial. Ischemic changes can re-appear just as easy as it disappears following your first 12-Lead and treatment.

Sometimes the prehospital 12-Lead is the only evidence that the patient’s chest pain was cardiac in nature. Imagine if this patient never received a prehospital 12-Lead, the biomarkers at the hospital came back negative maybe a patient with a high-risk lesion might be discharged home.

Remember that the 12-Lead ECG findings are NOT the deciding factor on whether or not to manage the patient using the Cardiac Ischemia Medical Directive. The Indications are "suspected cardiac ischemia" which include patient symptoms, NOT ECG findings.

Strive to get the first 12-Lead ECG prior to treating suspected cardiac ischemia.


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