Equipment 8-108 - Cardiac Monitor

CMH EMS & MIH Protocols

Scope of Practice:

• Emergency Medical Technician
• Advanced Emergency Medical Technician
• Registered Nurse
• Paramedic

Indications:

• Virtually all patient contacts.

Contraindications:

• If ALS is available, manual mode is preferred.
• Do not attempt blood pressures on injured extremities, side of previous mastectomies, or dialysis shunts.

Precautions:

• Exercise safety precautions.
• SpO2 accuracy is dependent upon adequate perfusion at probe site, bright ambient lighting, Poisoning, nail polish, and polycythemia.
• Cardiovert with extreme caution in patients on digitalis, beta-blockers, and calcium channel blockers.
• Do not place pacer electrodes directly over implanted pacemaker or AICD.

12-Lead and 15-Lead Acquisition Procedure:

• Attach limb leads.
• Preferred locations for 12-lead acquisition are wrists and ankles.
• Preferred locations for 4-lead monitoring are shoulders and abdomen.
• Attach precordial leads.
• Perform 12-lead.
• Perform 15-Lead on the following patients:
• Non-diagnostic 12-lead OR
• Evidence of acute inferior wall injury.
• Refer to Equipment 8-108-01 - ECG Interpretation Guide.
• Consider transmitting 12-lead to the receiving facility.

12-Lead Transmission procedure:

1. Ensure modem is plugged in the back.
2. Press "TRANSMIT" button.
3. Scroll to "REPORT" and select the correct 12-lead to send.
4. Scroll to "SITE" and select the correct destination.
5. Select "SEND" and wait for the confirmation print-out.
6. Call the receiving facility to discuss the transmission with medical control.

AED Procedure:

• Confirm patient is in Cardiac Arrest.
• Apply and connect combo-pads.
• Press "ANALYZE" or "CPR."
• Follow on-screen messages and voice prompts.

Manual Defibrillation Procedure:

• Verify patient is in Cardio-Pulmonary Arrest.
• Record baseline rhythm.
• Apply combo-pads (anterior-posterior is preferred).
• Select appropriate energy.
• Charge and clear patient.
• Call "CLEAR" and ensure patient is clear.
• Press "SHOCK."
• Reassess patient.

Synchronized Cardioversion Procedure:

• Explain procedure to patient.
• If time permits, consider Protocol 2-660 - Pain Control.
• Record baseline rhythm.
• Select lead with tallest R-wave.
• Apply combo-pads (anterior-posterior is preferred).
• Select appropriate energy.
• Synchronize ("SYNC") and observe markers on screen.
• Charge ("CHARGE") and clear patient. To cancel charge, press speed dial. If "SHOCK" is not pressed within 60 sec, charge is cancelled.
• Call "CLEAR" and ensure patient is clear.
• Press "SHOCK."
• Reassess patient.

Transcutaneous Pacing Procedure:

• Explain procedure to patient.
• Connect 4-leads and record rhythm strip prior to Pacing.
• Select lead with tallest R-wave.
• Apply combo-pads (anterior-posterior is preferred).
• Turn pacer on and set rate.
• Gradually increase energy until electrical capture is observed (usually wide, bizarre QRS).
• Check pulse for mechanical capture. If no mechanical capture, continue to increase energy until mechanical capture. If CPR is being conducted and no mechanical capture is detected at maximum energy, continue Pacing.
• Once mechanical capture is obtained, increase energy another 10%, assess blood pressure, and record rhythm strip.
• If CPR is being conducted, continue for another 2 minutes before discontinuing.
• If conscious, consider Protocol 2-660 - Pain Control.

Vitals Procedure:

• Choose and apply appropriately sized cuff. Auscultated blood pressure is required as a baseline to verify LifePak before medication administration.
• Attach pulse-ox probe.
• If patient is being transported ALS: Connect 4-lead cardiac monitor.

Refer to Equipment 8-108-66 - Cardiac Monitor Programming Standards.

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