As much as I complain about signing these damn things, I stopped giving them a hard time about ordering them.
My best "unnecessary" EKG was this lady in her 30s in front of the nursing station behind 4 other stretchers waiting to get a room. The call was for "dehydration" or something vague. She hadn't mentioned chest pain to the paramedics whatsoever. One of our veteran techs was standing there and talking to her and she mentioned that she was having a little chest pain. He decides to get an EKG which showed inferior STEMI. She started to get hypotensive on arrival in the cath lab. Big RCA lesion, successful PCI..did well.
Another cool EKG lately was one of my last shifts. Your typical seizure pt. Guy in his 50s, HTN, CHF, DLD, terrible historian, BIBEMS, hx of seizures, off his keppra for 3 days and had two back to back seizures PTA. Now resolved. He had some facial abrasions but otherwise was completely baseline and wanting to leave. No neuro complaints at all. No cardiopulmonary complaints. I start asking all my usual questions and find it a little odd that his features aren't typical. No postictal phase, no urinary incontinence, no tongue biting. In fact, most of the times when he has a seizure, he is completely lucid when he wakes up. I kind of scratch my head as I'm heading back to the desk, shrug, place some orders for labs, EKG, 1g Keppra, etc.. and start digging through his record. Turns out he's got ischemic cardiomyopathy with EF 25% and had an AICD that was implanted in the remote past but it was removed 2/2 infection about 1.5 years ago. About that time the EKG tech hands me his EKG showing NSR, non specific ST-T wave changes but a QTc around 630. I look at it some more, cancel his keppra and on my way back to his room ask our pharmacist to research any anti-epileptics that are not QT prolonging because I can't think of any. He says he can't either but will check. I ask the dude..."So man, how long have you been having these "seizures"?", "Doc, about 1.5 years I guess...", Me: "Well, it says here you had your AICD taken out 1.5 years ago....", "Yeah, got infected...hated that thing! Shocked the hell out of me."
Anyway, long story short... Long QT syndrome masquerading as a seizure disorder was my suspicion. I called our EP guy and he was all over it. I think they are going to place S-ICD. Damn EKGs come in handy sometimes I suppose...I still hate signing them though.
