Category: Other

when to put a cardiac monitor

Question #: 364


Is it an RPPEO expectation that we must always attach a cardiac monitor before administering any medication?


The ALS PCS is no longer specifying that a cardiac monitor should be applied prior to every medication administration. It is now mentioning that it should be applied in the presence of abnormal vital signs.

Cardiac monitoring is a diagnostic tool meant to support your patient assessment and working diagoses. It also assists you in monitoring your patient once a medication has been administered and adapting management plans when needed.

The BLS PCS provides specific patient care contexts where a cardiac monitor should be applied, meant as safety parameters. The BLS PCS identified patient care situations most at risk, where cardiac monitoring will support quality and safety.

Here is a list of patient care contexts from the BLS PCS where it is recommended to apply a cardiac monitor:

Any cardiovascular, respiratory or neurological compromise
All vital signs absent (VSA) patients, except those who are obviously dead as per the Deceased Patient Standard
Unconscious or altered level of consciousness
Collapse or syncope
Suspected cardiac ischemia
Moderate to severe shortness of breath
Cerebrovascular accident (CVA)
Major or multi-system trauma
Submersion injury
Hypothermia, heat exhaustion or heat illness
If requested by sending facility staff (for inter-facility transfers)

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