Category: Vital signs

Cardiac Monitor Needed with Medication Administration

Submission ID: 293


I was under the impression the cardiac monitor needed to be on prior to any medication administration however, some colleagues say that this is false as it only needs to be on sometime during the call. What is the Base Hospital position on this?


There is no “policy” stating when the cardiac monitor should be applied. We do feel that cardiac monitoring and rhythm interpretation is part of the information gathering process. We have also been advocating in CME to slow down and not rush into making a clinical management plan without all of the relevant information.

Perhaps an example of clinical relevancy may be of assistance:

When considering pain management for a patient where ketorolac or ibuprofen is being considered, we know that a contraindication to proceeding with either medication is the use of anticoagulants. If the cardiac rhythm is atrial fibrillation would you proceeds with ketorolac or ibuprofen or would you ask additional questions to your patient to explore the irregular heart beat and if medication is being used to prevent blood clots?

Atrial fibrillation usually requires long term use to anticoagulants to prevent blood clot formation and therefore a high index of suspicion for anticoagulant usage should be maintained whenever atrial fibrillation is identified. In this case, cardiac monitoring could prevent a medication error and improve patient safety.

Additionally, there are several locations in the Standards that suggest cardiac monitoring needs to be completed, but does not necessarily prescribe the exact time of its application

The ACR Completion Manual version 3.0 identifies ECG rhythm as an area to be filled out on the ACR which implies ECG monitoring should take place.
The BLS-PCS Patient Assessment Standard also identifies that cardiac monitoring is necessary if a patient is exhibiting signs or symptoms of cardiovascular, respiratory or neurological compromise, additionally several medical standards requires that Paramedics consider potential life/limb/function threats, such as, cardiac ischemia which again would imply a need to apply the cardiac monitor.

While this is not a black and white answer, I hope there is enough information to guide your clinical practice and can provide the bases for a conversation with your colleagues as it arises.

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