“10 Minutes, 12 Leads, and No Nitro Yet: Do It Right, Every Time”
Let’s set the stage:
You’ve got a chest pain patient.
Vitals are stable.
You’re thinking, “I’ll slap on some oxygen, toss ‘em a nitro, and then get that 12-lead while we’re rolling.”
🚫 Hard stop.
That order of operations? Not just wrong — potentially dangerous.
Let’s break down why the 12-lead comes first. Always. And within 10 minutes of patient contact.
⏱️ Why 10 Minutes?
This isn’t an arbitrary goal.
The American Heart Association guidelines for suspected ACS state:
“A 12-lead ECG should be performed and interpreted within 10 minutes of first medical contact.”
Why?
To identify STEMI early
To activate the cath lab quickly
To reduce time to intervention
To save heart muscle — literally
“Time is myocardium” isn’t a cliché. It’s math.
💊 Why Not Nitro First?
Because not every chest pain is created equal — and not every heart likes nitro.
Right-sided infarct (RVMI)?
Give nitro before the 12-lead, and you just dropped the preload and possibly tanked their pressure.Inferior STEMI?
That RVMI might be riding shotgun — and you won’t know that until you get that V4R lead.New LBBB? Posterior STEMI?
If you nitro before the ECG, you’re chasing symptoms without a diagnosis.
Treatment follows assessment. Always.
🧠 The Gold Standard Sequence:
Primary assessment / ABCs
Brief history (symptoms, onset, quality, risk factors)
12-lead ECG — before meds
Interpret findings
THEN initiate treatment (aspirin, nitro, O₂ if indicated, transport, hospital alert)
✅ Do it in this order = fewer surprises
✅ Do it in this order = more lives saved
📉 Common Excuses (and Why They Don’t Work):
“We were in a hurry.”
→ Cool. So was the infarct.“They already took nitro before we got there.”
→ Doesn’t mean you skip protocol. Still get the 12-lead immediately.“They didn’t look like a STEMI.”
→ Neither did the last 3 patients who were.
🛡️ Clinician-to-Clinician:
Getting the 12-lead fast — and before nitro — shows:
Clinical thinking
Protocol adherence
A focus on why we do what we do
And it builds trust with receiving teams, especially cardiology
🔚 TL;DR:
🫀 Get the 12-lead within 10 minutes of patient contact
💉 Do it BEFORE nitro to avoid harming right-sided or preload-sensitive infarcts
🧠 Build the habit now = better care later
🚨 Let the ECG guide your next steps — not just your gut
Because anyone can give nitro — but it takes a sharp provider to pause, assess, and diagnose first.
#BetweenTheTones
#12LeadFirstAlways
#10MinuteTarget
#DontGuessGetTheStrip