Re: Digest Number 5653

[Guest guest]

Even more interesting is the number of times that the electrodes are moved

once the patient gets to the ED.

I tried to make it policy for the tabs to be left in place when we were

expecting to repeat the EKG, but it was almost impossible to keep folks from

taking the stickies off the chest....most common was from the rad techs:

" The radiologist insists on having them off because it makes it more difficult

to read the chest xray. "

One cardiologist I worked with would use a skin marking pen to show where

he wanted the leads placed....

ck

In a message dated 08/29/10 03:38:21 Central Daylight Time, Gene Gandy

writes:

One thing that nobody has mentioned is that no matter where it's put, if

somebody else does an ECG later and places them in different places, even

slightly, the reading will be skewed and there will be differences even if

there have been no changes in the patient's coronary status.

One thing I do with my students to illustrate all this is let them play

with the electrodes and put them in all sorts of places and see how placement

changes things. It's one of the best ways to illustrate vector to them.

[Guest guest]

All this points to the great gaps in understanding that exist between the

various levels of care from prehospital to advanced diagnostic clinics. Medics

vs. nurses vs. ER doctors vs. radiologists vs. cardiologists vs. surgeons and on

and on and on.

We all have our own notions about what best practices are, but between different

specialties in the hospital, there are many conflicting notions and very little

interaction to iron out differences that could easily be fixed with a little

communication.

I monitor a list mainly occupied by physicians, and it's often hilarious, if not

stunning, to see the amount of conflict between them about little things just

like this. They get raging attitudes about their own wishes about how to do

things, rage among themselves, and almost never have a sit down and work things

out for the betterment of patient care. Patients don't really matter. It's the

egos of the practitioners that rule. Of course, they'll always say they have

the patient's best interests in mind, but if they really did, they would learn

to cooperate. Medical people are not great team players beyond one level.

There is a hilarious bunch of cartoons on U-Tube about doctors in different

specialties arguing with each other and putting each other down. The docs are

just as toxic toward one another as we in EMS are, perhaps moreso.

Why is it so difficult for the prehospital folks, the ER docs, and the

radiologists just to sit down and talk over the problem of removal of electrodes

and replacing them in different places, and working out a system for working

through that?

It's difficult, and impossible, because none of the people involved will put

their massive egos on hold long enough to even acknowledge that there's a

problem. And none of them will devote a minute of their " precious time " to

meeting with somebody in another level of care to try to work things out.

So little things happen, such as ECG electrodes being placed differently in

serial ECGs that cause changes that compound and complicate the complexity of

diagnosis. Nobody pays any attention to them until there's a bad outcome. Then

the lawyers get involved. Lawyers are, in the end, the best diagnosticians.

They always figure out what should have been done.

Wouldn't it be refreshing to see ONE example of everybody in a system sitting

down and talking about issues like this and working out simple solutions? Well,

don't count on it.

Gene Gandy, JD, LP, NREMT-P

PERCOM EMS Education

Tucson

Re: Digest Number 5653

Even more interesting is the number of times that the electrodes are moved

once the patient gets to the ED.

I tried to make it policy for the tabs to be left in place when we were

expecting to repeat the EKG, but it was almost impossible to keep folks from

taking the stickies off the chest....most common was from the rad techs:

" The radiologist insists on having them off because it makes it more difficult

to read the chest xray. "

One cardiologist I worked with would use a skin marking pen to show where

he wanted the leads placed....

ck

In a message dated 08/29/10 03:38:21 Central Daylight Time, Gene Gandy

writes:

One thing that nobody has mentioned is that no matter where it's put, if

somebody else does an ECG later and places them in different places, even

slightly, the reading will be skewed and there will be differences even if

there have been no changes in the patient's coronary status.

One thing I do with my students to illustrate all this is let them play

with the electrodes and put them in all sorts of places and see how placement

changes things. It's one of the best ways to illustrate vector to them.

[Guest guest]

All this points to the great gaps in understanding that exist between the

various levels of care from prehospital to advanced diagnostic clinics. Medics

vs. nurses vs. ER doctors vs. radiologists vs. cardiologists vs. surgeons and on

and on and on.

We all have our own notions about what best practices are, but between different

specialties in the hospital, there are many conflicting notions and very little

interaction to iron out differences that could easily be fixed with a little

communication.

I monitor a list mainly occupied by physicians, and it's often hilarious, if not

stunning, to see the amount of conflict between them about little things just

like this. They get raging attitudes about their own wishes about how to do

things, rage among themselves, and almost never have a sit down and work things

out for the betterment of patient care. Patients don't really matter. It's the

egos of the practitioners that rule. Of course, they'll always say they have

the patient's best interests in mind, but if they really did, they would learn

to cooperate. Medical people are not great team players beyond one level.

There is a hilarious bunch of cartoons on U-Tube about doctors in different

specialties arguing with each other and putting each other down. The docs are

just as toxic toward one another as we in EMS are, perhaps moreso.

Why is it so difficult for the prehospital folks, the ER docs, and the

radiologists just to sit down and talk over the problem of removal of electrodes

and replacing them in different places, and working out a system for working

through that?

It's difficult, and impossible, because none of the people involved will put

their massive egos on hold long enough to even acknowledge that there's a

problem. And none of them will devote a minute of their " precious time " to

meeting with somebody in another level of care to try to work things out.

So little things happen, such as ECG electrodes being placed differently in

serial ECGs that cause changes that compound and complicate the complexity of

diagnosis. Nobody pays any attention to them until there's a bad outcome. Then

the lawyers get involved. Lawyers are, in the end, the best diagnosticians.

They always figure out what should have been done.

Wouldn't it be refreshing to see ONE example of everybody in a system sitting

down and talking about issues like this and working out simple solutions? Well,

don't count on it.

Gene Gandy, JD, LP, NREMT-P

PERCOM EMS Education

Tucson

Re: Digest Number 5653

Even more interesting is the number of times that the electrodes are moved

once the patient gets to the ED.

I tried to make it policy for the tabs to be left in place when we were

expecting to repeat the EKG, but it was almost impossible to keep folks from

taking the stickies off the chest....most common was from the rad techs:

" The radiologist insists on having them off because it makes it more difficult

to read the chest xray. "

One cardiologist I worked with would use a skin marking pen to show where

he wanted the leads placed....

ck

In a message dated 08/29/10 03:38:21 Central Daylight Time, Gene Gandy

writes:

One thing that nobody has mentioned is that no matter where it's put, if

somebody else does an ECG later and places them in different places, even

slightly, the reading will be skewed and there will be differences even if

there have been no changes in the patient's coronary status.

One thing I do with my students to illustrate all this is let them play

with the electrodes and put them in all sorts of places and see how placement

changes things. It's one of the best ways to illustrate vector to them.

[Guest guest]

On Tuesday, August 31, 2010 01:38, wegandy1938@... said:

> Medical people are not great team players beyond one level.

That's because too many of them don't know their place!

Rob