Telemetry Techs vs. Nurses

[Jubei]

Who's better at reading rhythms?

I say the techs (I'm an LVN and a monitor tech by-the-by).

I hate nurses who can't tell the difference between a Wenckebach, a Mobitz II, or a dissociated AV freaking block.

[LetItBleed]

i think one thing that is forgotten is just because the strip says the heart is doing this or that via electrical stuff, does not mean the heart is physicaly doing this or that. as a tech your job is to inform the nurse of what you see thats it. a lot of odd strips show say VT but the tele is picking up 2 beats for every one real beat. so if the nurse went and checked out the patient and come back and said no he/she is not in VT you the tech will get mad and say the nurse is wrong.

I'm confused. The monitor tech observed Ventricular Tachycardia, informed the nurse, and got mad at the nurse because the patient self-converted back to the underlying rhythm? Or this scenario make-believe? I think if anyone in the hospital is aware of false alarms on patient monitors, it's the monitor tech.

even if you are right as the tech. who are you to say anything to the nurse.

The monitor tech has every right to say what he or she feels to be said to the nurse to insure she is completely 100% aware of what is happening with that patient's heart rhythm or other vital signs. If the nurse doesn't seem to comprehend what rhythm the patient is in, as this happens often, speak to the charge nurse. This is what they are paid to do.

JUST INFORM.

And this is what they do. And then you listen and act. If you are in the process of acting, as "wooh" has stated, then the real problem is a lack of communication. Why?

if my tech kept trying to argue with me weather i am right or wrong they are distracting me from giving my patients the best care i can. with that scenario the tech would no longer be benifical to patient care but, become a obstruction and need to be removed.

When did this happen? It takes two to argue. I would never neglect my patients to argue with anyone, be it a cafeteria worker or a Doctor.

is it possible your wrong and the nurse is right?

Always possible, not likely.

was this rhythm expected due to disease proccess or medications? is the pt going in for a pacer later or other procedure? all of these questions are for the nurse to review not you as the tech

When I was a tech, we were informed when patients were given certain medications or procedures that could affect their rhythm.

its not about patient safty its about your ego.

Who's ego is this about? I have a theory.

[thatoneguy]

I'm confused. The monitor tech observed Ventricular Tachycardia, informed the nurse, and got mad at the nurse because the patient self-converted back to the underlying rhythm? Or this scenario make-believe? I think if anyone in the hospital is aware of false alarms on patient monitors, it's the monitor tech.

actually this was a nurse and a tech that had seen a HR of 180ish called the doc. when the doc came in he took the pulse manualy and found a regular rhythm with a normal rate but the monitor was still showing 180 BPM. do you think the tech and the nurse should have argued with the doc and his findings? or just document what they obsvered. maybe they should have called every 30 min. to tell the doc the monitor is saying 180 BPM. you know until the doc is completely 100% aware.

The monitor tech has every right to say what he or she feels to be said to the nurse to insure she is completely 100% aware of what is happening with that patient's heart rhythm or other vital signs.

thats what i said. this was not just informing the nurse of the techs observation which they did but then disagreed. you dont as a tech have to keep telling the nurse what you think the rhythm is until he/she is in 100% agreement with you. the nurse disagreed but knew what the tech thought. again its not the techs place to tell the nurse she/he is wrong. just inform them of their observations.

If the nurse doesn't seem to comprehend what rhythm the patient is in, as this happens often, speak to the charge nurse. This is what they are paid to do

yeah i believe i said that too. you forgot to quote this "if there is an issue of competency there are steps that can be taken none of which involve arguing with that person. all you can and should do is report it via talking to the manager and/or doing a incident report "again reporting-informing not arguing" or this one "if there is a real danger to the patient the tech should inform the manager." did you miss those.

And this is what they do. And then you listen and act. If you are in the process of acting, as "wooh" has stated, then the real problem is a lack of communication. Why?

but what this tech did is more than inform. after informing there nurse of the rhythm the nurse said no its not that is this. instead of looking at the patient or telling the manager the tech got the 12 lead ekg to prove they were right, this goes beyond informing.

When did this happen? It takes two to argue. I would never neglect my patients to argue with anyone, be it a cafeteria worker or a Doctor.

if is the key word here. i said if my tech. not when my tech. i also said i love my techs. personaly i never have argued with anyone about the care of my patients.

When I was a tech, we were informed when patients were given certain medications or procedures that could affect their rhythm.

thats good but does not always happen. infact the techs usually have to ask. i have never seen the techs get a medication report on a patient and updated everytime a medication might be ordered or D/C'd that effects the rhythm, as standard thing. what i have seen is a tech ask about it and the nurse say yeah the patient is on this or that. sometimes they are informed but not always.

Who's ego is this about? I have a theory.

i bet you do.

[LetItBleed]

actually this was a nurse and a tech that had seen a

HR of 180ish called the doc. when the doc came in he took

the pulse manualy and found a regular rhythm with a normal

rate but the monitor was still showing 180 BPM. do you think

the tech and the nurse should have argued with the doc and

his findings? or just document what they obsvered. maybe

they should have called every 30 min. to tell the doc the

monitor is saying 180 BPM. you know until the doc is

completely 100% aware.

Odd. Both a nurse and technician could not differentiate between the waveform of extreme tachycardia and 'normal rate' (defined as 60-100bpm, sinus). You've established that the monitor was alarming 180bpm, about double the normal rate. This is not uncommon in the case of inverted or peaked T-waves in Lead II, or MCL. But, merely glancing at the on-going tracing appearing at the patient's bedside should have told a different story. Perhaps simply running a routine rhythm strip would have rendered a verdict without the participation of a doctor. I don't think we have all the facts.

Regardless, I can now see that you're referencing a certain situation, a certain nurse, and a certain technician. I know some outstanding nurses, and and I know some horrible nurses. Likewise, knowledgable technicians do exsist, along with not-so-knowledgeable technicians. However, in my experience, 12-leads are a good resource when the change is rhythm is sustained. I can't say this was entirely a bad idea. Our hospital did a mandatory stat ekg on all significant rhythm changes. Let me clarify, our technicians are informed only of potentially significant medications or procedures such as Digoxin, Cardizem, Intubations, and ART/Central lines. It seems your hospital suffers from a serious lack of communication and I fear this could spell R.I.P for a patient, someday. Furthermore, I'm not sure why you have explained the monitor tech's job roles and responsibilities twice on this thread, as they do vary greatly from hospital to hospital. If you want to tell people what to do, I suggest you pursue a higher nursing degree and enter administration.

Let this topic not reflect the LVN vs. RN topics. Technicians, LP(V)N's, and RN's - we're all coworkers. We all have our own specific job duties and responsibilities. In the interest of our patient's well being, let's tolerate one another and remain professional and make the best out of our shifts.

Concerning argumentive techs and nurses, that's a local matter. Very unprofessional. As a patient, I can't say I'd feel safe being monitored by such a overly zealous technician or treated by such a combative nurse.

Something to think about: A doctor removed a pacemaker from a 50-something patient and admitted that patient to CICU. The patient appeared to run 1'AVB after the removal. But the monitor techs believed the patient was suffering from 3'AVB with near-identical atrial and ventricular rates, yielding only one P-wave per QRS with a elongated PR interval, suggesting 1'AVB at a glance. Considering the techs observed the patient continiously, they noted that when the patient's heart rate varied, which wasn't often, it revealed other P-waves that marched through the strip during bradycardia, but when the heart rate rebounded to "normal" a few moments later, all the P-waves except one were buried again, giving the illusion of 1'AVB to the untrained eye. They informed the nurse who became confused. Armed with rhythm strips, one of them spoke with the charge nurse who agreed and informed a resident as they made their rounds that morning, who ordered a 12-lead and diagnosed 1'AVB (no bradycardia at the time). With the charge nurse's backing, the techs insisted but left it in the doctor's hands. The patient went to the floor and then home at some point, and we all read his obiturary less than two weeks later.

But back on topic. I agree with nursemaa.

[chadash]

quote:actually this was a nurse and a tech that had seen a HR of 180ish called the doc. when the doc came in he took the pulse manualy and found a regular rhythm with a normal rate but the monitor was still showing 180 BPM. end quote

How does that happen? I dont understand....

NOw excuse this totally uneducated and clueless question: is it possible for the palpable pulse to be different than the activity in the heart? could you have a atrial rhythm of 180 and a pulse more like 80? Guess that would be clear on the monitor though, just clueless here!

[hrtprncss]

quote:actually this was a nurse and a tech that had seen a HR of 180ish called the doc. when the doc came in he took the pulse manualy and found a regular rhythm with a normal rate but the monitor was still showing 180 BPM. end quote

How does that happen? I dont understand....

NOw excuse this totally uneducated and clueless question: is it possible for the palpable pulse to be different than the activity in the heart? could you have a atrial rhythm of 180 and a pulse more like 80? Guess that would be clear on the monitor though, just clueless here!

Yes Chadash, Don't trust the monitor. It can be showing one thing, and something else may be happening:) I know you're studying ACLS and one example for you to remember is PEA/EMD.

[thatoneguy]

my point was very simple. the tech told the nurse what they observed. the nurse understood what the tech said. the nurse interpreted something else. the tech kept trying to tell that she was (the tech) right and the nurse was wrong. my point, the tech should not keep trying to tell the her(the nurse) interpretations were wrong, but instead inform the manager of the misinterpretations, thats it. just dont argue. thats all i said and/or meant.

personaly if there is a question i get a group to look at it. the example i gave was sometime ago and in one of my clinical rotations. guess which hosptial. its in L.A. California, give up. its Martin Luther King Drew, AKA killer king.

and no i dont work there. this is the hospital you hear about staff sleeping or just negelecting their patients. i did notice one thing there. techs and nurses are always argueing with eachother(nurse to nurse tech to tech and nurse to tech, cna's too) but i never seen any of them take the right course of action and notify management of the issue they were argueing about. perhaps this is why i am so into this not because i am sideing with anyone but because i believe we should use the system in place and take the appropriate action. not take sides and argue. i think i need to work on my explainations a little huh.

anyway chadash, letitbleed is talking about heart blocks. AVB=atrioventricular block.

[chadash]

Yes Chadash, Don't trust the monitor. It can be showing one thing, and something else may be happening:) I know you're studying ACLS and one example for you to remember is PEA/EMD.

yeah, that was what lead me to ask that question, but what I was wondering is could you have an actual radial pulse of 80 (not pulseless) and have EMD....or are you saying the monitor is off if the pulse is 80?

Oh, and thank you.....It is great that you are taking the time to explain this....I just don't think I am getting this:coollook:

[chadash]

\.

anyway chadash, letitbleed is talking about heart blocks. AVB=atrioventricular block.

I totally agree about the workplace conflict, where folks get in a knot over who was right, who was wrong: what a waste of time. Teamwork that focuses on getting it right for the pts sake, thats where we need to go with this....

Also, you folks explain things great, just remember, I am a nursing assistant and don't have much to pin this too, so my questions may have obvious answers that I just dont have the context to put them in.

Ok, the AV block is when the atrium is ticking along, and there is a block keeping all the impulse from going to the ventricles. Could the monitor be taking the atrial rate, and the dr be feeling the ventricle rate, cause thats the one that perfuses, or would this be obvious on the monitor? I got to get me one of those monitors....

[hrtprncss]

hey chadash...EMD is kinda old think of it as PEA....PulselessEA....So if you have a pulse then it's not PEA...If it show's 80 then it correlates....:)

[thatoneguy]

the monitor just picks up electrical pulses. there is a period immediately following a discharge of a nerve impulse during which the cell (in the heart) cannot be induced to fire again called the absolute refractory period. the SA node fires the heart does not react to the impulse but the monitor picks it up. the SA node is located on top of the right atrium. and yes in heart block the SA node fires and the AV node "blocks" or actually slows the impulse. the doc is feeling the actual heart rate, the monitor is picking up the impulses. hope i explained it ok.

[chadash]

I get it! Yeah!

Thanks for all

[thatoneguy]

your welcome. no prob.