Not all doctors can read ekg strips?

[GardenDove]

I had a pt for two days, and he had converted to a-fib for the first day of having him, he was 95 with copd, no big surprise. I got an ekg and informed the doc. The next morning he was still in a-fib, a coorificer looking rhythm that looked almost like a flutter in places. His heartrate was still 100-120, rather than the 80's he was in to start with.

We couldn't find the ekg, so I showed the strip to his doc, who is a family practise doc, very nice guy. Well he said, "looks like he's back in sinus rhythm, there's a p wave". So we got into a little friendly argument where I pointed out that not every one of those waves had a qrs, and it was still a-fib, or maybe a-fib/ a-flutter.

After he left (I just finally dropped the subject) I discussed it with my co-worker. It was definately a-fib, in fact that afternoon he converted back to sinus rhythm, with a clear pattern of 1 p wave followed by 1 qrs and HR in 80's.

Anyways, I was surprised that a doc didn't know how to interpret a rhythm strip. He must not get enogh practise and just reads the interpretation on the EKG report? A-fib is pretty basic.

[NicoleRN07, RN]

You're right, a-fib is pretty basic, but family practice docs usually don't have a lot of experience interpreting cardiac rhythms. Usually, they rely on the cardiologist or the ER docs to interpret the rhythms. The best thing you can do, is chart well and post a strip in your notes....CYA!!!

[muffie, RN]

and what about the ecg's he reads in his office ?????

yikes

[SCRN1]

In nursing school, we learned basic arrhythmias. Since I didn't use it for years, I forgot how to read strips. (I now work on a tele floor and had to take tele classes and relearned them.) I'm sure all doctors are taught how to read them in med school and like us, "if you don't use it, you lose it".

[ginger58, ASN, RN]

When I sent my dad to an internal med doc that a classmate of mine adored (adored his practice of medicine) my dad had an EKG. I remember this doc saying that he would send it out to a cardiologist to read as they were the best trained. An RN probably could read the strip better than a lot of general docs!!

[UM Review RN, ASN, RN]

We're required to do a 12-lead for confirmation if a patient converts from whatever to something else.

So I guess at the point of the disagreement, you might've asked for an order to get a confirming 12-lead. Would've let the doc know and allowed him to save face too.

[CHATSDALE]

i have known some really with it nurses who couldn't read a strip if their lives depended on it

on the other hand i knew a particular md, the kindest thing you could say about him was a dumb, stupid idiot but he could read a strip upside down and across a desk...go figure

[tvccrn, ASN, RN]

and what about the ecg's he reads in his office ?????

yikes

Why would he read any in his office? Most of them go to the cardiologists for a final reading.

Heck, here the primary doctor wouldn't even see the EKG at all.

tvccrn

[banditrn]

When I worked in ICU, I could read an EKG better than some general practice doc's, but so what? That's not their specialty. The cardiologists were better than I or the obstetricians, but I'll bet they'd crap if they had to deliver a baby!

[lauralassie]

I'm just amazed at how many people think it's OK for a Dr. to not know EKG's. I'm a critical care/er nurse. I wouldn't let a new orientee through orientation if they couldn't read basic EKG. How can that Dr. RX meds if he doesn't know how they are used. How can he evaluate lab work , DX or anything else for that matter. Not using it is no excuse. I havn't had to help open a chest in a long while, but you can bet if it happens , I had better be ready. Real Dr's won't tolerate incompetent nurse, if that sort of thing continues, I would consider reporting him to the medical board. There may be more going on than can be seen at first glance.Medical boards will invesigate inappropriate care. You never know how many people may have already reported him. Actually as RN's we are obligated to do that. Reading an EKG is one thing but knowing basic rhytms is another . He doesn't have to be able to DX an anterior MI, but Afib is common and basic.

[lauralassie]

in nursing school, we learned basic arrhythmias. since i didn't use it for years, i forgot how to read strips. (i now work on a tele floor and had to take tele classes and relearned them.) i'm sure all doctors are taught how to read them in med school and like us, "if you don't use it, you lose it".

that should make interesting conversation between a juge for malpractice and the dr. "but you honor, i havn't seen afib for weeks, i didn't remember what it looked like. i'm sorry, if i would have remembered the pt. may not have thrown a clot to his brain. well next time i'll look it up , i promise!" now can i go , i have a golf game.

[blueheaven]

You know the saying, if you don't use it you lose it...same way if you have EKG reading skills. I've had docs read the computer interpretation at the top of the EKG and go with that (when it was wrong). My concern Garden Dove, is the patient. If he is flipping in and out of A-fib to SR he needs to be anticoagulated/ASA therapy to prevent thrombus formation.