Tuesday, July 30, 2013

The sine wave EKG

Wired has a good story on germs resistant to modern antibiotics.

Lots of fake smoke, but also lots of real problem in the story to worry about.

Back to the good old days of dying from minor infections that ended up killing you...


Unrelated anecdote about paying attention to one problem and overlooking another.

When I was a medical, the problem was penicillin resistant staph.

So those with infections were put into an isolation ward, where they didn't spread it (but maybe where the care of other problems was lousy). The care was low level, sort of at a nursing home level, which was not good news if you got a really bad problem unrelated to your infection.

So when the nurses reported one patient was having symptoms, I was sent to the isolation ward to see a patient I didn't know and do an EKG...(I was a student, and didn't have much experience in EKG reading, but we were given "scut" work to do, so the hospital didn't have to hire a low level aide to do the work...).

So I got the EKG machine and found it was rarely used and no one ever fixed it. I could only get two leads to work, and got a strange sine wave pattern.

I showed it to the intern, a woman who hated me and the other female student, and she bawled me out and told me to find another machine.

So I searched around and found another machine, and redid the EKG, and voila, again it was a sine wave pattern.

Source: http://cdn.lifeinthefastlane.com/wp-content/uploads/2010/01/ECG_Hyperkaemia_L.jpg
so again, I took the EKG up to show to the intern, knowing I would again be bawled out in public for being incompetent. Luckily, she was talking to the Resident, who grabbed it out of my hand and said "Oh My GOD".

Her potassium was 8, a fatal level, but sometimes due to a "false positive" lab error if the blood hemolyzed. So the laboratory didn't call us with a "headsup", but the result was put into the "inbox" at the nurses station at 3 pm, which was about the time the resident took over and started treating her for diabetic related hyperkalemia.

(she survived).

So I often complain about all those regulations we have to follow, but these regulations were put into place to prevent things like this: A lab result that was a dangerous level would now be required by law to be called to the doctor, the first EKG machine, (which was rarely used) would be checked ever month or so by someone that it worked...

----------------------------------- a version of this was cross posted to BNN.

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