EKGs in triage

VCUBen · Apr 6, 2009

Hello, at our ER ALL EKG strip print outs go to the MD. I think this is a critical part of CP management and just becasue the doctors get bombarded is not a reason to pawn it off on the nurses. The RN should be ACLS working in an ER anyway so they would have a general idea if a MI is evident. I have worked at the current place for over a year now and have never had to bring a pateint immediatly from the waiting room solely on the result of the EKG. We try to get the patient back the first second a room becomes open which is usually minutes. I hope this answers your question. Why type of system does your ER run. We have a no wait system and we see about 250 patients a day.

Displaced · Apr 6, 2009

Bombard the physicians. This is what they have trained and studied for. I would hate to have some one waiting in triage who goes into an arrhythmia because their ECG looked like sinus but actually showed Brugada. I know, very rare, and I HATE writing that, but in the ER, we have to think of worst case scenarios. To ease the load on the ER docs, I have any Cardiologist floating around take a look. I have to constantly remind them that I am not looking for just abnormal (since many are), but for something that may kill the patient soon.

We tried a no wait system for a few hours..... it was working until amount of patients coming in > amount of rooms available.

AnnieOaklyRN, BSN, RN, EMT-P · Apr 7, 2009

I am both a paramedic and an ER nurse, with my medic backround I am very comfortable reading EKGs.

I would suggest to your manager that you have a class for RNs so that they learn at least what to look for as far as acute changes. You would have to have some way of proving that they are competent in doing so after the class, but it may take some of the work away from the physiicans so they can concentrate on patient in the er already.

The other problem though is that no acute changes on an EKG does not mean that it is not cardiac. When I do triage, if there is any possibility that the patients chest pain or other complaint is related to an acute coronary syndrome, I don't care if the EKG shows no acute changes, they are going back as soon as possible where htey can be monitored and labs etc can be started.

The only reason I do EKGs in triage is to pass the time while the charge nurse finds a bed, or if it is a very low ACS risk.

Sweetooth

JStyles1 · Apr 7, 2009

ekg in triage

take it immediately to a physician to read

no st changes = try and get the patient back asap to a room

st changes = take the pt back immediately for mona, even if it involves sitting them in the hall

in my ER we try to hold pts in triage/waiting room/subwaiting if we are getting full so that we have at least 2 rooms open at a time. this way we can accommodate for incoming EMS and pts that immediately need a room (stroke, mi, etc)

mwboswell · Apr 7, 2009

The only reason I do EKGs in triage is to pass the time while the charge nurse finds a bed, or if it is a very low ACS risk.
Sweetooth

Really?

I guess that is okay if you can find a bed and get them in it and do the EKG w/in the time limit.

You do know that the current AHA "Get with the guidelines" recommendation is to have the EKG done and READ, by a MD, within 10 minutes of ER arrival?

Of course this isn't done to identify just "cardiac" versus "non-cardiac" - this is done for the purposes of identifying active STEMI's and rapidly acitivating your STEMI team.

Editorial Team / Moderator · Apr 7, 2009

When I do an EKG, I show it to a physician ASAP. As an ER RN and a volunteer paramedic in an area in which medics do 12-leads, I have interpretation skills; however, in the ER setting, I'm going to make sure an MD/DO takes a look at the EKGs. I have to say that many of the RNs I work with are well versed in EKG interpretation, and they know a STEMI when they see it. We often get our STEMIs out by chopper to the cath lab in less than 30 minutes. So yes, time is muscle ... bombard the physicians!

mmutk, BSN, RN, EMT-I · Apr 8, 2009

It is and should be the standard to get EKGs on any patient with CP, SOB, or otherwise noted ACS systems within 10 minutes of arrival to the ED.

If we can get the patient straight to a room in the ED we do it there, otherwise they will get one in triage and then be sent back out to the lobby if there are no ST changes. For patient's with multiple visits to the Hospital an old EKG is pulled up while performing the current one so a comparison can be made when you take the EKG to the ER doc.

What I do is... 1.Triage patient while an ER tech assists me with an EKG.

2. If I don't see any acute MI or new LBB changes I finish the triage and send them back to

WR and pile it with any other EKGs I have done. I then start the next CP in line with the

same story.

3. Every 5 minutes one of the ER techs take any EKGs that need review to an ER Doc for a

signature.

4. If i see suspicious changes or an acute MI or I don't care what the EKG looks like but the

patient looks like a heart attack, I take them back find a room or hallway and finish the triage

backthere.

5. Ohh and I almost forgot I do a fingerstick CK-MB Troponin on those going back out to WR as

well

AnnieOaklyRN, BSN, RN, EMT-P · Apr 10, 2009

Really?
I guess that is okay if you can find a bed and get them in it and do the EKG w/in the time limit.
You do know that the current AHA "Get with the guidelines" recommendation is to have the EKG done and READ, by a MD, within 10 minutes of ER arrival?
Of course this isn't done to identify just "cardiac" versus "non-cardiac" - this is done for the purposes of identifying active STEMI's and rapidly acitivating your STEMI team.

Apparently you read my message wrong! I will restate it. When I am in tirage, I triage the patient (which takes about 5 minutes), and then have an EKG done WHILE THE CHARGE NURSE LOOKS FOR A BED IN THE ER. The tech that does the EKG or myself bring it to a physician for reading, AGAIN WHILE THE CHARGE NURSE LOOKS FOR A BED. I guess you didn't quite understand that I am doing the EKG BEFORE they even have a more permanent bed!

As both a paramedic and an ER nurse I am WELL aware of why and EKG is done as soon as possible, I didn't start working in emergency medicine yesterday.

Sweetooth

allnurses Guide · Apr 10, 2009

We have a small room next to triage with a bed in it, if no beds available or just really busy and we want to know if they need to skip the line, get the EKG there. We have a designated lead MD, that gets problems flipped to, and he/she has to initial the EKG as having been read/evaluated. Then take it from there.

ERjodiRN · Apr 10, 2009

we call a "code 10" for all our chest pain patients. which means we get the pt. back immediately and the ekg with MD at bedside within 10 min. chances are, we've started an iv as well within that time. if there isn't a bed available, we make one...wherever that may be. ekg still in 10 min. while some nurses are great at reading ekg's, it's important that an MD have the final say and that it still be read by one within 10min. we also have a bed next to the main traige area for lobby ekg's. we use it sometimes if there is nowhere in the back for a cp pt., or if someone is presenting with atypical symptoms and has risk factors.