Are You Up for the E2B Challenge?

In the October 2008 issue of Emergency Medical Services, our very good friend Ivan Rokos, MD makes some comments that are worth repeating.

“[P]aramedics are now in a novel role, where they are able to diagnose STEMI faster and earlier than ever before using a prehospital EKG machine. This is important for two reasons: One is that hospital ED overcrowding has become a big issue and it’s sometimes challenging for a walk-in STEMI patient to have an EKG in a timely manner in an ED where staff and beds are pushed to the limit. In contrast, paramedics provide one-on-one care, so they can do a prehospital EKG very quickly. The second thing is that it’s increasingly recognized that a prehospital EKG done in isolation means nothing unless it’s acted upon by the receiving hospital, which can get its ED, cardiac cath lab and ICU ready to receive the patient when he arrives…”

“It’s very exciting in 2008 that paramedics are in a unique position to trigger a whole cascade of events that can make a big difference in a STEMI patient’s life,” says Rokos. “Basically, the clock has always started at the hospital door. The current cardiology guidelines recommend that the blocked artery should be open within 90 minutes from the hospital door to balloon inflation, but we want to push it up another notch, raise the bar on perfusion speed and set the clock not at the hospital door, but in the patient’s living room or office, or wherever the prehospital EKG shows a STEMI. That is the idea of the E2B Challenge.”

Are you up for the E2B Challenge? Join the E2B listserv here.

2 Comments

  • KT says:

    Are we to measure the "E" in E2B as the first field ECG and not time at scene? How do you measure the full process if we don't measure on scene to balloon?

  • Tom B says:

    KT – You are correct in that the consensus seems to be moving toward 9-1-1 call or arrival on scene.The argument for E=ECG was that we measured "discovery" to treatment. But what if EMS fails to perform a PH12ECG?Tom

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Comments
know it all parapup
83 Year Old Male: Shortness of Breath
@ Kyle I would question your authority to call out people for not having a license or being a know it all parapup when your tx basically entails "call medical control." I think we can both agree that his cardiac output is not great at all. I assume your reluctance to give him any other…
2014-10-30 20:26:11
Kyle
83 Year Old Male: Shortness of Breath
Well st elevation in avr and v1 associated with anterior and lateral depression would call for possible posterior wall MI. 15 lead would be in order. Also check all the leads for appropriate placing. If v7, v8, and v9 show the elevation i would treat as a STEMI per my protocol. Asprin only until medical…
2014-10-30 18:14:05
Tim
The most awesome STEMI test on the internet!
Thanks for the app. It made me think about all that one may see in the field. The only problem was I never got a score or saw the results of how I did other than saying I had completed the test. Anyway a great way to get the old brain working.
2014-10-30 13:14:27
Brian
83 Year Old Male: Shortness of Breath
I mostly agree with dustin. I believe this is may be an isolated posterior MI. The R wave in V2 points to it being a posterior MI. otherwise it is a 1st degree av block with a LAHB. I am somewhat concerned with the concordant t segment depression noted and in fact if you were…
2014-10-30 04:22:44
Karl Brennan
Understanding Amiodarone
Great article , however in VF caused by hyperkalemia it should be avoided along with lidocaine , Since it shuts down the K channels, the eiteiology of the arrest hyper K, K channels are needed to exchange K in the cell. Calcium , Bicarbonate, dextrose and insulin should be used to decrease K levels along…
2014-10-30 03:04:45

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