ramona223

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How common is it for routine ED EKG readings to point out something "abnormal" in the comments section of the print-out?
I've shadowed at several ED's and was also a recently admitted for food poisoning/fluid loss/syncope.
I know that when I shadowed in 3 different ED's, it seemed like pretty much every patient's EKG said something about an "abnormality" in the interpretation/comments (text) section. My own recent reading said "prolonged QT" but no one ever brought it up at any point during my stay in the ED. So I'm curious to know if most peoples' readings will say something along the lines of "abnormal" in the comments, but one actually goes by the graph itself?
 

RustedFox

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About 98% of EKG readings (going on my limited experience as a medical student matching into EM this year) in the ED will have "abnormal EKG" or some derivative in the comments margin. Normal can vary from person to person, especially given the clinical scenario - so you always read the EKG yourself and make your own value judgments.
 

southerndoc

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Today I had an EKG for a patient with pericarditis that read "Inferior ST Elevation - Consider Inferior Injury or Repolarization Abnormality. PROBABLY NORMAL" Never seen the computer spit out "Probably Normal" before. (It was capitalized by the EKG machine.)
 
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crewmaster1

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Today I had an EKG for a patient with pericarditis that read "Inferior ST Elevation - Consider Inferior Injury or Repolarization Abnormality. PROBABLY NORMAL" Never seen the computer spit out "Probably Normal" before. (It was capitalized by the EKG machine.)
Kind of off topic, but I was reviewing a patient's labs from an OSH yesterday and next to a very low bicarb there was an asterisk, and rather than saying low or critical low it said "PANIC" in all caps. I found that pretty entertaining (I think the EM doc followed suit and did panic because shortly there after he called our helicopter to get the patient which is why I got to see the lab results).
 

Febrifuge

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When I was an ED Tech, I'd make the machine print out a regular copy of the EKG for the resident, and I'd print a duplicate for the med student without the computer jibber-jabber. Learning to read EKGs, the attendings told me step one is to ignore that stuff.
 

AmoryBlaine

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When I was an ED Tech, I'd make the machine print out a regular copy of the EKG for the resident, and I'd print a duplicate for the med student without the computer jibber-jabber. Learning to read EKGs, the attendings told me step one is to ignore that stuff.
Step one of reading EKGs is to make sure it's the right patient and the mV scale is correct. :D

Good lesson: on an EKG machine read the numbers are usually reliable (QTc, PR, QRS, axis) but the read is highly variable and should be approached w/ skepticism.
 

Febrifuge

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Step one of reading EKGs is to make sure it's the right patient and the mV scale is correct. :D

Good lesson: on an EKG machine read the numbers are usually reliable (QTc, PR, QRS, axis) but the read is highly variable and should be approached w/ skepticism.
Indeed -- but the interpretation is the only thing this machine left off. All the info one would need to read it is still there.
 

southerndoc

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When I was an ED Tech, I'd make the machine print out a regular copy of the EKG for the resident, and I'd print a duplicate for the med student without the computer jibber-jabber. Learning to read EKGs, the attendings told me step one is to ignore that stuff.
If there is something on the interpretation that you disagree with, you should note it when you sign the EKG (note it on the EKG itself).
 

Febrifuge

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I can understand that, but circling the computer's output and scrawling "OK" or "agree," or crossing out something or writing "OK" or "normal" is surely no easier than just writing your own quick interpretation. Not to mention there will be a note which addresses the EKG findings...

Anyway, it's an interesting point, but to re-iterate: when I was printing these out as a tech, the attending or senior resident would get the "regular" printout and the student would get the one with the computer's interpretation left off. The attendings felt that this was a nice way to help teach EKG interpretation -- remove the training wheels.
 
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