American ER Doc Gone Walkabout Episode 022
An older gentleman with quite severe Parkinson’s hadn’t opened his bowels for about a week. He came to the ER – solver of all problems. He had a nice normal pulse when taken the old fashioned way – by placing the nurse’s trained fingers upon the radial pulse. And, he – appropriate to the modern world of high tech – was placed on an ECG monitor – for constipation. The ECG monitor showed a nice, regular, narrow complex tachycardia at 180 – exactly corresponding to his Parkinsonian tremor. The nurse knew what was going on, the resident knew what was going on, the monitor tried to convince everyone otherwise – red flashing lights, clanging bells, ringing klaxons. (Perhaps the monitor was actually trying to scare the sh!t out of the constipated patient – we should have let it go on longer to see if it would work.) The nurses, techs, residents seemed quite content to continue working through the flashing lights, and the din.
Here’s my suggestion to you, as it was to them: When one of your devices is providing you with information that you know to be, and are absolutely certain is, wrong and misleading:
TURN OFF THE F#@KING DEVICE!
The consultant (me) was so much happier and calmer with a dark monitor screen, no lights, no bells, no whistles.
On an unrelated note: our new monitors have the ability to put whatever tracing you wish in whatever position you prefer on the monitor screen (our old monitors always had the ECG tracing on top, and the pulse ox on the 3rd line). Last week, we had a patient who’s muscle tremor was repeatedly alarming, so one of techs very wisely just disconnected the ECG monitor and left the pulse oximeter connected – with a very nice pulse wave and good oxygen saturation. And, to make life easier, moved the pulse ox from its traditional 3rd line onto the top line, previously reserved for the ECG monitor. The consultant (for the Americans, that’s the attending) who shortly entered the room was perplexed at the healthy appearance of the patient, and the calmness of Lloyd, the tech, and all the others in the room – despite the wide complex ECG rhythm. After providing a series of orders (does he have a pulse?, check the potassium, let’s get the defibrillator pads on and the defibrillator in the room, give some mag, give this, do that) – the attending crawled away, tail between my legs, after being informed by Lloyd that the pulse oximetry tracing was actually supposed to look like that, there was no ECG tracing, and that he correctly had surmised that the ECG monitor was giving us only misleading information and in anticipation of my future instructions had:
TURNED OFF THE F#@KING MONITOR.
Good on ‘ya, Lloyd.
Next time: Sore throats and the learned professional
American ER doc