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This post could very well be titled, “What you say can matter.”  A lot of times, EMS practitioners feel ignored, as if nobody in the ED is listening to them.  I would like to share an example that proves that sometimes, they are heard loud and clear–whether they are wrong or right, incidentally; it’s a lot like playing the telephone game, with the magnitude of the mistake only enlarging every minute.  Today’s anecdote comes from some time I spent in an ED some time ago in medical-student mode. 

An ambulance brought in a patient from a personal care home, where care workers (who are mostly not trained medical providers) noted that this asymptomatic older gentleman had an irregular heart rate and promptly called 911.  The medic was really proud that he had managed to capture some of the funky heart rhythm on his monitor (and that pride was the first thing that alerted me to make a copy of the EMS strip):

To me, this looked very little like A-fib and very much like a shiver or tremor artifact.  Fortunately, the strip was taken on a LifePak 12, and I could just look a couple inches lower to see what lead III looked like:

Funny how those pesky artifactual complexes tend not to show up in other leads, isn’t it?  (If those strips aren’t big enough to read, you can get a huge version here–816 kB, which includes lead aVF.)

I presented the patient to the attending doc, with a plan to do a whole lot of nothing.  The doc immediately reversed that plan, saying that the strip didn’t look like plain A-fib.  (I agree here; the complexes have such regular R-R intervals that there could very well be P waves hiding under the interference.)  So a totally asymptomatic patient who couldn’t even be proven to have A-Fib got what probably amounted to a $15,000 workup (including at least one night in the hospital) because someone who may or may not have been a nurse planted a mental seed that grew and grew as it was transferred from listener to listener.

So yes, medics, the docs are listening.  It may not always feel like it, but your words do get heard…even if it is second-hand listening.

(And dear readers, if you interpret this strip as anything other than artifact, please let me know your reasoning.)

Filed under: EMS, Emergency Medicine