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.
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.
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.
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.
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."
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")
vamedic4, EMT-P
1,061 Posts
:yeahthat: :yeahthat:
That's the long and short of it.