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.

[vamedic4, EMT-P]

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".

:yeahthat: :yeahthat:

That's the long and short of it.

[neneRN, BSN, RN]

Any chance it was MAT rather than A-fib? MAT is fairly common in elderly pts with COPD and is commonly mistaken for A-fib because its an irregular rhythym and P waves will have varying morphologies or be hidden because of the increased rate.

[Indy, LPN, LVN]

I had a patient once in paroxysmal MAT that at first glance looked like v-tach. The tele monitors sure thought it was vtach. He got transferred to our unit specifically so we could start to poor fella on amiodarone. Did I mention his lung status was crap? We were sure the doc wouldn't have ordered amiodarone if he'd actually eyeballed the patient. That patient was an absolute train wreck; and eventually he did get an amio drip, just not the first night I had him as a patient.

[Jennifer, RN]

I have run across many docs (including ER docs that may be treating YOUR fatal arrthymia) that can not correctly interpret a rhythm. As the nurse, I have had to say to an ER doctor before "that is not the appropriate ACLS protocol for that rhythym, how about....". I tell new orientees to the ER that it is important to know your rhythms, but I stress that if interpretation is difficult then at least know when something looks different than SR and have someone with more experience interpret.

[MissJoRN, RN]

I don't have a problem with a dr not being able to read a strip or some other skill he rarely uses. It's OK, that's why we have specialists and hospitalists. I do have a problem with him not being able to admit that to himself an others. "Hey, that looks like sinus to me, what do you think? Well EKGs aren't a big part of my practice so let's run that by the cardiologist on consult before we make any changes."

[Kyrshamarks, BSN, RN]

You all do know the definition of a double blind medical study?

Two Orthopedic surgeons looking at an EKG.

[lauralassie]

Yes, thank you. We all have to cover each others backs to give good care. Most nurses and Dr's in the ER I work in are happy to do that. (notice I say "most")