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- by TT2seven Jun 6, '12Does any one know of any unit in IL that they critical care nurses read 12 leads and then initate a code stemi?Last edit by Joe V on Jun 6, '12
- Jun 6, '12 by nikkicoliCCRNThis seems like it might be out of scope of practice. It takes years of practice to read 12 leads. I don't know many nurses who are skilled at this nevermind required to be skilled at this. This seems more like an advanced practice skill and requirement. I honestly don't know many nurses that can read 12 leads nevermind treat based on one and I've worked in several ICU's over the years. I don't live in IL but I've never heard of this.
- Jun 6, '12 by Esme12Welcome to AN! The largest internet nursing community.
What does your Code Stemi mean and what does it entail. In order to answer your question properly I need to have more detail. I have been a critical are nurse for 34 years and I have "read" the EKG and started treatment as per a protocol after the 12 lead was scanned or faxed to the MD. In Illinois and Indiana.
What is your question exactly?
- Jun 7, '12 by AltraRecognizing ST elevation and actually activating the cath lab are two different things. Anyone ACLS-certified should certainly be able to recognize such.
A physician needs to be notified immediately upon discovery of the ST elevation - hopefully cath lab activation follows within minutes of that.
- Jun 8, '12 by jkr2020788First off, I'm a little confused. Your post's title is "Non Stemi", then you go on to talk about reading 12 leads? NSTEMI means NO ST elevation, so a code stemi would not be activated. Non-stemi or NSTEMI would not always show up on an EKG, just because there is ST depression, does not always mean NSTEMI. NSTEMI is diagnosed by clinical symptoms and elevated labs values. Now if a patient complains of sudden crushing chest pain and I do an EKG and see ST elevation that isnt related to pericarditis or something, I can tell you that I would have standard ACS protocol meds in one hand and my other hand busy dialing an MDs number. Id probably tell another nurse to contact house sup to get ready to get cath lab out.
Now on the other hand, a patient complains of chest pain and there are no EKG changes I would administer O2, and whatever meds the Pt already has ordered that fall under MONA, then I would precede to call the MD who will probably in turn order some cardiac workup and whatever other meds needed for standard chest pain treatment. If a normal trop has turned to a high trop, and/or you see EKG changes, there is a high probability of NSTEMI and the MD would plan accordingly. My particular hospital does not do emergent caths for NSTEMI unless it has progressed to ST elevation >1mm or there is a new onset bundle branch block (BBB). Ive read a good bit of literature that says some hospitals do do emergent caths for NSTEMIs, but most of the hospitals I have exp with do not. I suppose different hospitals have different protocols but that is what Ive seen.
- Jun 8, '12 by TT2sevenQuote from TT2sevenmy hospitals policy reads:Does any one know of any unit in IL that they critical care nurses read 12 leads and then initate a code stemi?
identfiying st elevation, LBBB and inferior wall MI - inferior wall mi I feel is a Medical dianosis, and I feel it would take alot of training to read a 12 lead so throughly. More then ACLS any thoughts?
- Jun 8, '12 by jkr2020788Any nurse in the ICU should be able to easily look at an EKG and readily be able to see if a patient is having a heart attack. The only STEMI that is not easily recognizeable is the posterior MI. Which every ICUnurse should know that chest pain + new onset EKG changes and you should definitely start to get ready for calling an MD to confirm while you are also getting everything you need ready (MONA).
How is inferior wall MI hard to see on an EKG? ST elevation in II, III, and AVF.
The "hard one" is posterior, which isnt really that hard. You will see new onset of ST depression in the V leads. A cool trick you can do if you see new onset ST depression in V leads with chest pain is to take the paper printout of the EKG, hold it up to the light, flip it upside down (to where you are looking at the back) and rotate it 180 degrees ( the right side is now on the left). You will now see ST elevation in those leads. Doing the above steps is like looking at the heart from the back and you can see the electrical activity of the posterior portion.
- Jun 9, '12 by Esme12Quote from TT2sevenI still don't understand what you are talking about. What does "calling a code stemi" mean? Does it mean you notify cath lab and inciate labs or do you start thrombolytics? There are some EMS response teams tha tinciate thrombolytics in the field.my hospitals policy reads:
identifying st elevation, LBBB and inferior wall MI - inferior wall mi I feel is a Medical diagnosis, and I feel it would take a lot of training to read a 12 lead so thoroughly. More then ACLS any thoughts?
I think to activate a response team the ACLS is a good baseline. Is the ST elevated or not. LBBB is pretty clear. Inferior wall MI? is ST elevation in Lead 2,3 and AVF. I am not sure what has you concerned so we can best answer your question.
I am originally from Indiana/Illinois and yes....we were taught to read 12 leads and know to notify the MD and inciate interventions( IV nitro, ASA, call cath lab) ....and that was more than 18 years ago.