EKGs in triage?

Specialties Emergency

Published

We are looking for a way to decrease our door to EKG time (particularly for possible STEMI patients). Do any of you do EKGs in triage to screen patients for possible MI? If so, how do you do this? I vaguely remember learning that EKGs need to be done supine (not sitting), but I am trouble finding written evidence. Any suggestions? I am trying to write a protocol, and get the necessary equipment in the triage room (stretcher vs. reclining chair). I need to justify what I recommend. Any help would be greatly appreciated. Thanks!

Specializes in ICU and EMS.

When I went through my CNA/PCT training, I was told that an EKG is supposed to be done with the patient in a supine position. If the patient is for some reason unable to lay back (ex: severe respiratory distress), then mark the position of the patient on the EKG.

Sorry, I don't have any literature to back this up!! Good-luck in finding some!

Up Vote Up Vote ×
Specializes in Emergency.

Everyone and their brother complains of chest pain because they think its going to get them brought right back to a room. I for one like the fact that facilities are finally doing EKG's on these very unlikely cardiac pts before they ever get to the back. Fortunately we dont seem to be as overwelmed with them as we use to be- I think we have over time taught the paient population here that if you dont have chest pain dont c/o chest pain.

Now if all the belly pains would stop. I swear one shift half the dept was being preped for abd/pelvic CT's. And we all know how long those take.

R

We do the abbreviated triage/chest pain screening on ALL chest pain pts (except those 25 and under with no CAD Hx or street drug use).

However, the whole chest pain process has been so pounded into our triage nurses' heads that they send anyone who mentions the words "chest pain" through it...i.e., even the "I have N/V, diarrhea, and fever, and oh by the way, I had chest pain 3 days ago," so its really overused, and a lot of crap goes through the screening area, potentially backing up our true chest pains...so I do think some criteria identifying your truly at risk pts would help.

Up Vote Up Vote ×
Specializes in Trauma Administration/Level I Trauma.

Our door to EKG time at my facility is LESS than 5minutes, so far we have been almost 100%.

Up Vote Up Vote ×

IF they come in via EMS, a 12 lead is done in the field and transmitted. Otherwise we have a medic or EMT in triage that does EKGs, labs, and IV starts on all chest pains.

Up Vote Up Vote ×
Specializes in Emergency Department.

When a patient comes to our ED with cc "Chest Pain" our registration clerk pages overhead for an EKG in Triage. We have a paramedic room with a bed and an EKG machine, so they go there and get an EKG before they are even triaged. Often they go ahead and get vitals too. The EKG is shown to the MD, who either just says, "OK" or "Get this person to a room now" and we go from there. if no EKG changes, we finish the triage and get blood work in triage if we don't have a room. If EKG changes or whatnot, we find somewhere for the pt. Our EKGs are usually within 5 minutes.

Up Vote Up Vote ×

We do EKG's in triage on a regular basis. While the standard is usually to lay the pt down, sometimes that just isn't possible. We have, when absolutely necessary, done EKG's on pt's while they were in the tripod position, and on two occassions, done the EKG with lead placement on the pt's back. The facility and practice standard may be for the pt to be laying down, but you have to think outside the box when the normal just isn't possible. Our triage EKG's have cut our time down to 5 min from door to EKG in most cases. If the doctor thinks that something is up, they will as for a repeat EKG when the pt hits the bed. Hope this helps.

Up Vote Up Vote ×
Specializes in Emergency department.

we do EKG's in our triage, we started with 2 triage rooms, but ended up remodeling our triage area to include two curtain areas for EKG's, we also have an EDT at triage to do our EKG's we have reduced our door to EKG time tremendsly and actually sent patients to cath lab from triage. P.S. we started with a chair that reclines to do the ekg's but now have strechers

Up Vote Up Vote ×
Specializes in ER, ICU,L&D, IV team, M/S, HS, IMCU, SNF.

I have worked in more than one hospital that the volume at times was so overwhelming that chest pains could not go immediately to a stretcher. At both hospitals, the triage assessment and vitals were done along with an EKG. The EKG was immediately seen by an attending and signed with no STEMI or the pt was flagged to be seen next. If the impression was no STEMI the pt cardiac panel was drawn and sent for analysis. There was either a seperate room or a curtain with a stretcher for obtaining EKG's and an ER tech or EKG tech to assist triage. If you had back to back CP pt's EKG's could be obtained while another was triaged to keep the flow going. Hope this helps!

Up Vote Up Vote ×

Our mangement deems any cp to require an ecg, doesn't matter if they are 9, 19 or 90. When I'm charge, I tend to keep one bed open or use our hallway gurney for the protocols (CP, SOB, Abd pain, CAP) and if they are stable and without other risk factors, they tend to go back out to the waiting area while the labs cook.

Major Domo

Up Vote Up Vote ×
Specializes in Emergency/Trauma/Education.
Everyone and their brother complains of chest pain because they think its going to get them brought right back to a room....

Now if all the belly pains would stop. I swear one shift half the dept was being preped for abd/pelvic CT's. And we all know how long those take.

R

EKGs for all chest pains...screening rectal exams for all belly pains...:lol2:

Up Vote Up Vote ×
+ Add a Comment