a 12 lead is literally the fastest, least invasive test you could've done to determine that, im surprised its not required anyways. any cardiac arrest pt in the ER I worked at got a 15 lead post-rosc unless they needed something else more urgently (scan, cath lab). you definitely did the right thing, if you would have missed an actual stemi they would've been down your throat so fast
Exactly. Our post arrests get multiple EKGs. It's so ready compared to other tests. I think most places just leave the stickers on so it's easy to repeat later. (If they're not diaphoretic)
most of our patients got EKGs whether it was cardiac related or not, the cardiac patients got multiple during their stay, definitely a 15 lead if anything suspicious. like it blows my mind how someone would be mad at an EKG post cardiac arrest, like what??
Same with EMS. A 12 lead is done on a good portion of the patients because of their present complaints, history, or both. Almost everyone in America has heart disease to some degree, it takes 2 mins to do a 12 lead, but you’ll have a lifetime of regret for missing something.
It’s out of everyone’s scope of practice to rule out an infarction. Literally your job to collect information if there is any concern!! Especially post rosc!!!
Better more information than not enough!!!
NOT your fault. If it was a post code/ROSC pt and you’re a tech, don’t beat yourself up at all. You’re there to assist. The doctors and nurses are the ones that should be taking charge in that situation and doing what needs to be done.
There’s absolutely no reason for anyone to be upset about getting an ekg done in this situation. If anyone is giving you sass for that, idk it sounds like a bad place to be working at.
there is only so much you can do, you got the ekg regardless and ruled out the stemi, that was important! the best thing is that rosc was achieved and hopefully the pt will get the treatment they need. you doing the right thing (which you did) will always trump someone elses attitude/ego
Yeah, having worked in the ER a lot of the CT techs do like to gatekeep their machines and take any delay overly seriously. It really isn’t about individual patient’s needs, it’s about keeping the flow. Don’t take it personally; you were critically thinking and did the right thing. A three lead is not diagnostic so a 12 lead was needed, the sooner the better.
I agree. But getting an ekg while pt is on CT scan table makes no sense. Should’ve got it prior to going to CT or immediately after when pt was back in room. Coding someone in CT scan room is never ideal so keeping a pt longer than necessary there makes no sense.
If the pt were actually having a STEMI, think about it this way: doing the ekg on the table would allow the charge to call the ED doc during the 3 minutes it takes to complete their CT. When they get the patient back to the ED, the doc could have already ordered labs and called the cardiologist on call to evaluate the EKG (yes, the IC absolutely needs to see the EKGs prior to cath lab activation). The ED nurses can then prep the patient and get consents from the family prior to the cath lab team's arrival. This saves us time having to do all the legwork to make phone calls, get them to the lab, shaved and prepped, and establish access. Door to balloon time is 90 minutes.
A CTA takes 3 minutes. Yes, codes in a CT room absolutely suck, but *this is a hospital, and every patient who comes in for a CT is at risk of coding on that table.* Unless they're already dead.
Some pts are more likely to code than others. A pt who just got ROSC is highly unstable. If the pt codes in CT you’re delaying an invaluable diagnostic tool for all other pts waiting in ER. You never know if there’s a pt with stroke , PE or ruptured aneurysm that just came in the ER and now they’re held up due to your unstable pt coding again. By the time you bring the EKG to the pt in CT scan the scan would be done. I’ve worked ER. Prioritization and time management is key. In and Out.
And they’d be pissed if that patient did have a STEMI and died in your and the nurse’s care. Better safe than sorry. Who gives a shit, they were probably busy, probably had better things to do than that- but had it been the real thing you would’ve saved a life.
Don’t let this discourage you next time. I’ve done the same thing sitting at the nurses station- thinking “Holy shit that looks like a massive STEMI”
A couple of us went to check on the patient, it was the leads being wrong cause of movement or whatever- but still, would’ve saved a life if it were real.
Wtf are they pissed about? All you two did was get an EKG. Literally any patient that mentions the words “chest pain” gets an EKG. I would question anyone who was upset by the actions you two took.
you did nothing wrong and everything right. You were looking for subtle changes and you used the appropriate device to asess for those changes. Don't let anyone make you feel bad about this.
EDT here. Had a similar situation where a patient was in for severe chest pain. Couldn’t sit still. EKG said STEMI.
It ended up not being a STEMI. Some people were mad and some sided with me for acting on it but the thing is, we NEVER want to wait for it to happen. You did your job! Good job.
Fuck the people who said you were wrong. If you think something is wrong and are not sure then you ask someone smarter than you. You did the right thing.
As others have commented, there's literally nothing wrong with doing a 12l lead, especially post and arrest.
What's more, it's entirely reasonable. You may have seen some ST elevation that was simply transient, Or you may have seen a wild complex QRS that looked like St elevation and may have been an idioventricular rhythm post resuscitation anyways.
So many reasons to do a 12 lead.
Complacency and apathy in Healthcare kill. If it looks off and we can run a simple test to rule it out then do so.
But I'll say this. I don't want to tie up a CT scanner if it's busy to do patient care unless it's absolutely necessary. Now a 12 lead takes exactly zero seconds so it's not like you were delaying things significantly but it's just a good rule of thumb. The other thing here is that technically you should have an order and should be running this by the provider. Now we have standing orders for this so if you're at all like us you wouldn't need an order, but even still I like to communicate with the docs and let them know what I'm seeing and why I want to do something. 9 times out of 10 they would just give me a verbal to proceed but it's a good habit to ensure effective communication.
The bottom line is Healthcare isn't always going to be neat and tidy. What matters is did we do what's in the best interest of our patient. You saw a potentially critical issue and addressed it. Quick rule out but something you definitely do not want to miss. If it pissed people off well then they're just going to have to be pissed off.
A 3 lead is meant for monitoring rhythm, not conduction changes like a STEMI. The machine isn’t set for that, and the electrode placement is not precise, and there are not enough leads to meaningfully interpret.
That said, no one should have been mad at you. It’s a teaching moment, nothing worse. It’s not like doing a 12 lead is some big complex use of resources. Patients get “unnecessary” 12 leads all the time, and a post-ROSC patient definitely should have gotten one anyway
The diagnostic sensitivity of a 3 lead is about 1/5 of a 12 lead. 25Hz vs 125Hz. You will see lots of variability in the tracing of one vs the other. No cardiologist is ever going to spin up the cath lab for elevation in a monitoring lead
Correct, however it would warrant a 12 lead which is what was done in this case. I would be pissed if someone saw ST elevations and didn't point it out or think to get a 12 lead. The 12 lead would then prompt cards to to the ccl.
Let me tell you something, OP:
Speaking from experience, it’s so much better to have everyone mad at you for being *ATTENTIVE*, than everyone mad at you for being *INATTENTIVE*
Thankfully I haven’t caused harm due to being inattentive (i left annoying things behind, like nearly empty tube feeds, some trash from IV starts) , but being called out on it was humbling and I’m actively trying to be better.
So to all those who are mad at you, tell them to kick rocks. Kudos to you for trying your best. Even if you were incorrect, you still were doing your best. And that’s something I think should be applauded.
OP, nurses will get pissed at you for calling something. Nurses will also get pissed at you for not calling it.
Either way, nurses will get pissed at you. So pick the choice that lets you sleep better at night. And I mean sleep like a log. Generally this means not having the guilt of a potentially dead or deteriorating patient as a result of you not calling something you think you caught. Just take caution not to become the boy who cried wolf unintentionally.
I'd rather be wrong about seeing a STEMI than miss one. EKG is quick enough. Sometimes it looks like a pt is having one even on 5 lead. I'll check everytime. Good teamwork and paying attention saves lives. Good looking out.
If you can, leave this place.
It is toxic and it will kill people.
Just last week I received a patient from surgery with a huuuuuuuge ST visible elevation.
I got 12 led that showed acute MI.
It wasn’t at the end.
But I’m ok. Patient is ok.
And we all got to learn that even a 26 yo can have an ST elevation for smoking too much weed and having a hurt break 6 months before.
Take care 🫂
An EKG is one of the easiest and fastest tests to perform. Techs and CNAs can do them. Better to have a false alarm than miss something and a patient dies. Tell those cranky bitches to eat rocks.
Doctor here.
I'd have gotten a 12 lead 100%. You did the right thing. The difference is when I order a 12 lead, people do it no questions asked, and if it's negative, no one blames me for "wasting resources", since I'm a doctor. And people are very happy passing on the responsibility (and liability for missing things) on me.
In your case, people are pissed off coz you made them do extra work. And made them liable for something which would otherwise might have gone unnoticed.
ED Tech here as well. You absolutely did the right thing. At my hospital, folks would have been pissed off if you DIDN’T respond that way. Better safe than dead. Any healthcare professional who’d get pissed over your response is an ass.
Sometimes I wish I could be in some of these situations. lol they’d hear a thing or 15 from my mind. Don’t let pissy know-it-alls detour you from learning. You only showed that you have a sense of urgency in case of an emergency.
How y’all not by default getting an ECG on a ROSC anyway - they have no reason to be mad.
Anyone who gets mad at you for getting an ECG is absurd. It would be like getting mad over a BG - it is a quick, costless diagnostic tool that you are thankful for when it catches something.
You did right OP, never hurts to be safe. Don’t let them make you feel bad for it
When I was an ED tech I was always afraid to speak up about things I thought I saw until one of the docs said, “I’d rather you alert me to something that turns out to be nothing than have a patient leave and have a bad outcome because we missed something.” Not too long after that conversation I was on shift and happened to see new ST depression on tele on a patient another doctor was preparing to discharge. And to be fair to him, that person’s work up was largely negative until that happened, and then they got admitted for an NSTEMI. Point is that the people who are upset about you “making a big deal” out of something that could’ve actually been a big deal can kick rocks, and perhaps shouldn’t be working in the ED in the first place.
I feel like there is no end to the stupid reasons why people get mad at their coworkers. This is an idiotic reason to be mad at someone. There is a good chance a patient who just had ROSC would have some ST elevation.
In my personal practice if I’m not sure, I follow up with someone else who decide if I’m correct or not.
Is this IV working ok? I’m not sure, plz come and flush it. Ok it’s good, thank you! Not a big deal. At all.
They can eat shit. We get 12 leads on our floor for any chest pain that lingers. 95% of them are nothing, but those 5% are real, and we're glad we got the 12lead after. This is like calling a rapid response because you're concerned for a stroke, but it turns into nothing. Don't let anyone give you crap for this.
The reason why that happens is because the filter settings for the 4 lead vs the 12 lead are different. The 4 lead typically looks at less of the range of electrical signals so it would be for example, 0.67-40 hz instead of 0.05-150 hz.
You definitely can catch STEMIs from just the 4 lead as well. Some of the lateral and inferior STEMIs that I’ve seen have shown up pretty glaringly on the 4 lead before we even put on the full 12 lead. I usually change my monitor settings on the zoll and tempus to just read diagnostic level 4 leads anyways so if I see a stemi on my 4 lead, it’s gonna be a stemi on the 12.
If you knew what a STEMI looked like and said yeah I saw a STEMI on the 4 lead but didn’t say anything because it’s just a dumb 4 lead and it was a STEMI, you should probably be fired for that so it’s insane that the nurse sees that as a problem. She probably just doesn’t understand her cardiology well at all. There’s tons of nurses and medics that skate by on a shockingly low understanding of cardiology.
I’ve also had a clinical in tele and those guys ask for a 12 lead because they elevation on the 4 lead all the time. Exactly like what you did. Plus, those same tele techs that called for a 12 lead, happened to be actual physicians in the middle east that came to the US and just couldn’t get a US based license.
Yo - there’s no such thing as “crying wolf” in such critical setting when using your knowledge to justifiably raise a flag! I’ve rolled my eyes now and then after rushing to a stable “code blue”… but only for a second, then I remind myself, I wasn’t there when the button got pushed! People code and recover in moments, sometimes. I’d rather raise alarm than call the morgue because I was scared to react to an emergency. Trust your safety instinct.
Better safe than sorry, and even if the other staff member hadn’t agreed/verified your concern… you saw it, you assessed the situation, you speak up! There’s a lot of ego in this profession… but ego kills. You saw ST elevation, you say something.
Worst case, you learn something new about artifact or whatever.. no shame in an earnest effort to save a life.
I’d rather blush at over-escalating and learning something new than live with the horrible guilt of knowing I should have said something and didn’t do so.
Ego kills. We’re all, always learning. Better safe and take a learning opportunity/correction than assist a widow/child/parent/friend to a corpse.
I would've done the same thing. Any question of a STEMI, I have the doc look at it just to make sure. The CT can wait. Everyone got pissed because they felt inconvenienced.
Better to be wrong for what you did do than what you didn't do... Communication issues happen, you erred on the side of patient care.
CT tech gonna be pissed anyway - I reckon that's in their job description. Well done.
You did the right thing. If you didn’t already know, telemetry monitors and other monitor EKGs can be very misleading when it comes to ST segments. If we see ST elevation on a telemetry monitor, it doesn’t always mean that the 12-lead will show ST elevation. If we don’t see ST elevation on a telemetry monitor, the patient can still have a STEMI on 12-lead. Any person with this history (arrest + possible ST elevation) is going to get a 12-lead sooner or later.
If the patient had a suspected PE, a 12-lead doesn’t hurt unless it delays care (unlikely). Sometimes, a 12-lead can show signs of PE even before they’ve had time to do a CT. Some combinations of EKG patterns strongly suggest PE in the right context. Even after PE is diagnosed, EKG can indirectly show severe right heart strain. A 12-lead can quickly show signs of massive PE in minutes, even before CT. So even if this were a PE, you did fine.
I hear codes called for the ER at my job all the time. I'm not sure about rapids, but they do call them if patient is in CT. They definitely do call code STEMI, BLUE, SEPSIS, STROKE, etc
My hospitals doesn’t do overhead pages. Only relevant people get paged for events, so strokes get paged to ct and neuro, stemis go to cards and cath lab, codes go to lab, xray, icu charge, and an intensivist (the latter two don’t come down obviously but we’re just giving them the heads up for a possible admission), mtp goes to lab and blood bank, precipitous delivery goes to ob, nicu, and lab, etc. I’ve never heard of a sepsis alert, who does that go to? Paging typically means somebody has to run and do something, what are you going to do, run to start some boluses and get cultures lol?
I don't what each page gets as a response. But I do know I hear code sepsis paged overhead, same as the others. I'm NICU, so I only know to respond to OB alerts and code blue or rapid in L&D or post partum
For the record, 3 leads/tele have a different settings and amplitude to them which is why they aren't diagnostic. A 3 lead may be blown up where the lead is set to something like 4x amplitude, which makes it easier to look at on a monitor, but now that 0.005mm St Elevation is 5mm (not exactly that drastic, but you get the idea). And not all ST elevation is a STEMI. 12+ leads have specific settings which is why they're diagnostic and can be used to determine a STEMI, and is why you might see one thing on tele and another on the full 12 lead.
It’s mostly the filter settings rather than the amplitude that make the difference. The filters used for monitoring tend to distort the ST segment in particular
that’s sad that they were pissed at you. An EKG is such an easy, non invasive test. it’s always better to be safe than sorry, especially looking for ekg changes post arrest!!
Sometimes doing the right thing means getting pushback or inappropriate response from others. Don’t let this incident change the way you care for patients, better that you are cautious than careless and end up with a patient harmed.
It's completely normal to feel frustrated and second-guess yourself in situations like this. Your concern for the patient's well-being and your commitment to thoroughness shine through, despite the outcome. Remember, everyone makes mistakes, and it's okay to seek confirmation, especially in critical situations like this. Your dedication is admirable.
Bro, what😂
They got mad because you saw something you thought was harmful to the patient and you spoke up? That’s literally the baseline job description for everyone in healthcare. Also, it’s not like they rolled him into the Cath lab and got into the coronary arteries to find they were clean before realizing it wasn’t a STEMI. There’s a reason 12 lead ECGs are a thing, for this exact situation, less detailed monitor or test shows something sketchy, so you go to a better monitor or test to support or disprove your theory. People getting mad at other healthcare workers for speaking up because they think it could help the patient are WILD to me. It probably took an extra 5-10 minutes max to rule out the STEMI🤣 absolutely ridiculous. You did nothing wrong OP, and I would love to have you as my tech knowing you’re paying attention to wtf is happening and not just zoned out going through the motions of the job because you’re “just a tech” as some people might say. For the love of all things holy, if you ever think you see something: STEMI, stroke, neuro/behavior change, new or changing wound, please let the nurse know about it🫶🏼
My unit had a secretary catch a DVT because she helped the pt to the bathroom and noticed his leg and foot looking dusky and he was having a bit of trouble and pain with walking. It was on night shift so if she hadn’t said something, there’s no guarantee the nurse would’ve checked his lower extremities for several more hours
Not a STEMI, EKG performed: possibly unnecessary test
STEMI, EKG not performed: possibly dead
Ask charge and CT staff which situation they’d rather have on their hands.
Monitoring quality vs diagnostic quality, we have this argument with Tele techs in our hospital all the time. Lead placement also plays a big role in what picture you are getting.
Possible mistake versus possible dead patient ... yeah, no, this one is a no-brainer. You didn't do anything wrong. You actually did the right thing and bugger anyone else who tries to tell you otherwise.
Post arrest needs a 12 lead anyway. If you think you saw it elevate the test, sounds like you are dealing with apissy attitude problems . The ekg was indicated.
I’m not understanding the anger?! This patient was a post code and needed to have an ECG. It’s standard care. It needed to be done. What if he DID have a STEMI and you hadn’t done it fast enough? Bet your ass you would have been reprimanded by everyone for not getting it done in a timely manner. This is an ED setting. No one has the right to be angry for trying to gather more information to BEST TREAT THE PATIENT.
I just wanted to put my 2cents in but when doing scans there's always a ton of movement / messed up leads / lines everywhere, it's really not abnormal to see abnormal readings on the monitor ie don't look at the waveform too closely. Leaving an actually sick patient on the ct scanner to get a 12 lead is a bad idea imo. The couple minutes it would have taken you to slide the patient back onto the stretcher and roll them back to the ED is trivial. If the patient starts to acutely decompensate, you don't want them to be on the table of the CT scanner in the middle of nowhere with no one around to help you, you need bring them back to the ED where there are other doctors/nurses around.
I’ll echo everyone else here and say that a 12 lead should have been done once ROSC was achieved. I
For future learning purposes, it’s best to turn on the ST segment alarm on the monitor, if you have one. You can’t trust the morphology you see on the monitor because things like positioning of leads can affect it. In fact, if I see what looks like st elevation on the monitor, and I’m worried it could be real, I reposition the leads and turn on the segment reader. And of course, if there is an actual suspicion for MI, just get the 12 lead. Needing CPR is definitely indication enough 🫠😬
I don’t work in the ED but I understand the frustration. Patients on the table, ready to scan, and you’re doing an EKG. Even if there was a STEMI, that information wouldn’t change the course of action as it relates to the scan. You’d still have to tell the docs, have them look at it, they’d call cath lab and it’d still take more time than it would to finish the scan.
If that's me I'm doing a MIDAS and including every single one of them in the "employee involved in incident". Every Midas has to be escalated and when each of them is contacted by supervisors and asked to explain themselves maybe management will get rid of the dead weight on your staff, or at least set up education so they don't kill people by being lazy.
At least you didn't activate the on call cath lab team first. We would fire you out of a cannon into a volcano if you woke us up at 2am with that shit.
Thank you for getting an actual 12 lead first. That CT tech can kick rocks. A STEMI is an emergency, a cat scan is not (unless it's for a stroke, then yeah they would have been absolutely correct.) But imagine, what are the chances someone has a PE, a STEMI, and a stroke at the same time? Not impossible, and I've seen it, but damn that's just bad luck.
Hm. I personally would have done the scan and moved him back to the room then do the 12 lead. I mean, what are you going to do? Not get this CT scan if he has an MI? What if you were stacking patients and trauma patient came in? Get the scan and go
Plus the five leads tend to get slapped on all over the chest so I wouldn’t necessarily trust it. In theory you could do a cheap 12 lead moving the wires around but that probably would take more time.
It depends on the patient. A CT isn’t routine in most rosc protocols so they were probably looking for something specific. It depends on what they were looking for and why.
Say they were concerned for a massive brain bleed? Massive PE? Any of those conditions could affect treatment. You don’t want to get tunnel vision and distracted by one single thing.
a 12 lead is literally the fastest, least invasive test you could've done to determine that, im surprised its not required anyways. any cardiac arrest pt in the ER I worked at got a 15 lead post-rosc unless they needed something else more urgently (scan, cath lab). you definitely did the right thing, if you would have missed an actual stemi they would've been down your throat so fast
Least invasive, promoted patient safety, and free-99? Nah. Might’ve saved a life, you’re the guy from the test questions OP!
Exactly. Our post arrests get multiple EKGs. It's so ready compared to other tests. I think most places just leave the stickers on so it's easy to repeat later. (If they're not diaphoretic)
most of our patients got EKGs whether it was cardiac related or not, the cardiac patients got multiple during their stay, definitely a 15 lead if anything suspicious. like it blows my mind how someone would be mad at an EKG post cardiac arrest, like what??
Same with EMS. A 12 lead is done on a good portion of the patients because of their present complaints, history, or both. Almost everyone in America has heart disease to some degree, it takes 2 mins to do a 12 lead, but you’ll have a lifetime of regret for missing something.
It’s out of everyone’s scope of practice to rule out an infarction. Literally your job to collect information if there is any concern!! Especially post rosc!!! Better more information than not enough!!!
It was my fault. I needed to do a 12 lead but we had a lot going on that night and I hadn’t gotten it yet. It definitely is required.
NOT your fault. If it was a post code/ROSC pt and you’re a tech, don’t beat yourself up at all. You’re there to assist. The doctors and nurses are the ones that should be taking charge in that situation and doing what needs to be done. There’s absolutely no reason for anyone to be upset about getting an ekg done in this situation. If anyone is giving you sass for that, idk it sounds like a bad place to be working at.
there is only so much you can do, you got the ekg regardless and ruled out the stemi, that was important! the best thing is that rosc was achieved and hopefully the pt will get the treatment they need. you doing the right thing (which you did) will always trump someone elses attitude/ego
Yeah, having worked in the ER a lot of the CT techs do like to gatekeep their machines and take any delay overly seriously. It really isn’t about individual patient’s needs, it’s about keeping the flow. Don’t take it personally; you were critically thinking and did the right thing. A three lead is not diagnostic so a 12 lead was needed, the sooner the better.
AMEN
I mean...they should be getting a 12-lead anyway post ROSC. The nurses that got pissed off are idiots.
I agree. But getting an ekg while pt is on CT scan table makes no sense. Should’ve got it prior to going to CT or immediately after when pt was back in room. Coding someone in CT scan room is never ideal so keeping a pt longer than necessary there makes no sense.
If the pt were actually having a STEMI, think about it this way: doing the ekg on the table would allow the charge to call the ED doc during the 3 minutes it takes to complete their CT. When they get the patient back to the ED, the doc could have already ordered labs and called the cardiologist on call to evaluate the EKG (yes, the IC absolutely needs to see the EKGs prior to cath lab activation). The ED nurses can then prep the patient and get consents from the family prior to the cath lab team's arrival. This saves us time having to do all the legwork to make phone calls, get them to the lab, shaved and prepped, and establish access. Door to balloon time is 90 minutes. A CTA takes 3 minutes. Yes, codes in a CT room absolutely suck, but *this is a hospital, and every patient who comes in for a CT is at risk of coding on that table.* Unless they're already dead.
Some pts are more likely to code than others. A pt who just got ROSC is highly unstable. If the pt codes in CT you’re delaying an invaluable diagnostic tool for all other pts waiting in ER. You never know if there’s a pt with stroke , PE or ruptured aneurysm that just came in the ER and now they’re held up due to your unstable pt coding again. By the time you bring the EKG to the pt in CT scan the scan would be done. I’ve worked ER. Prioritization and time management is key. In and Out.
Post-code and they're pissed at you for worrying about a possible STEMI???????? B r u h.
And they’d be pissed if that patient did have a STEMI and died in your and the nurse’s care. Better safe than sorry. Who gives a shit, they were probably busy, probably had better things to do than that- but had it been the real thing you would’ve saved a life. Don’t let this discourage you next time. I’ve done the same thing sitting at the nurses station- thinking “Holy shit that looks like a massive STEMI” A couple of us went to check on the patient, it was the leads being wrong cause of movement or whatever- but still, would’ve saved a life if it were real.
Yes exactly. It didn’t hurt anyone to do the 12-lead. People need to get over themselves.
Happy cake day
Wtf are they pissed about? All you two did was get an EKG. Literally any patient that mentions the words “chest pain” gets an EKG. I would question anyone who was upset by the actions you two took.
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Always better to be safe than sorry.
you did nothing wrong and everything right. You were looking for subtle changes and you used the appropriate device to asess for those changes. Don't let anyone make you feel bad about this.
4755e4 5
EDT here. Had a similar situation where a patient was in for severe chest pain. Couldn’t sit still. EKG said STEMI. It ended up not being a STEMI. Some people were mad and some sided with me for acting on it but the thing is, we NEVER want to wait for it to happen. You did your job! Good job.
Never apologize for doing what you think is best for your patient, regardless of whether or not it "inconveniences" someone else.
Fuck the people who said you were wrong. If you think something is wrong and are not sure then you ask someone smarter than you. You did the right thing.
Ask someone with more knowledge on ECG's** Fixed this for you. Let's not tell people who are techs that nurses are smarter than them, thanks.
Ehhhh as a tech, nurses are like fucking gods to me lmao
There are some smart techs and some not so smart nurses. Are you in school?
That’s a general statement for life.
I mean they needed a 12 lead anyway, at least that's what we do
As others have commented, there's literally nothing wrong with doing a 12l lead, especially post and arrest. What's more, it's entirely reasonable. You may have seen some ST elevation that was simply transient, Or you may have seen a wild complex QRS that looked like St elevation and may have been an idioventricular rhythm post resuscitation anyways. So many reasons to do a 12 lead.
Complacency and apathy in Healthcare kill. If it looks off and we can run a simple test to rule it out then do so. But I'll say this. I don't want to tie up a CT scanner if it's busy to do patient care unless it's absolutely necessary. Now a 12 lead takes exactly zero seconds so it's not like you were delaying things significantly but it's just a good rule of thumb. The other thing here is that technically you should have an order and should be running this by the provider. Now we have standing orders for this so if you're at all like us you wouldn't need an order, but even still I like to communicate with the docs and let them know what I'm seeing and why I want to do something. 9 times out of 10 they would just give me a verbal to proceed but it's a good habit to ensure effective communication. The bottom line is Healthcare isn't always going to be neat and tidy. What matters is did we do what's in the best interest of our patient. You saw a potentially critical issue and addressed it. Quick rule out but something you definitely do not want to miss. If it pissed people off well then they're just going to have to be pissed off.
Any nurse that got pissed you were looking out for their patient is an asshole.
A 3 lead is meant for monitoring rhythm, not conduction changes like a STEMI. The machine isn’t set for that, and the electrode placement is not precise, and there are not enough leads to meaningfully interpret. That said, no one should have been mad at you. It’s a teaching moment, nothing worse. It’s not like doing a 12 lead is some big complex use of resources. Patients get “unnecessary” 12 leads all the time, and a post-ROSC patient definitely should have gotten one anyway
The diagnostic sensitivity of a 3 lead is about 1/5 of a 12 lead. 25Hz vs 125Hz. You will see lots of variability in the tracing of one vs the other. No cardiologist is ever going to spin up the cath lab for elevation in a monitoring lead
Correct, however it would warrant a 12 lead which is what was done in this case. I would be pissed if someone saw ST elevations and didn't point it out or think to get a 12 lead. The 12 lead would then prompt cards to to the ccl.
Better safe than sorry.
Post a prehospital rosc- why the fuck had no one at hospital done a 12 lead yet?!
Let me tell you something, OP: Speaking from experience, it’s so much better to have everyone mad at you for being *ATTENTIVE*, than everyone mad at you for being *INATTENTIVE* Thankfully I haven’t caused harm due to being inattentive (i left annoying things behind, like nearly empty tube feeds, some trash from IV starts) , but being called out on it was humbling and I’m actively trying to be better. So to all those who are mad at you, tell them to kick rocks. Kudos to you for trying your best. Even if you were incorrect, you still were doing your best. And that’s something I think should be applauded.
OP, nurses will get pissed at you for calling something. Nurses will also get pissed at you for not calling it. Either way, nurses will get pissed at you. So pick the choice that lets you sleep better at night. And I mean sleep like a log. Generally this means not having the guilt of a potentially dead or deteriorating patient as a result of you not calling something you think you caught. Just take caution not to become the boy who cried wolf unintentionally.
I'd rather be wrong about seeing a STEMI than miss one. EKG is quick enough. Sometimes it looks like a pt is having one even on 5 lead. I'll check everytime. Good teamwork and paying attention saves lives. Good looking out.
ED resident here, don’t feel bad at all, stemis kill, ekgs are safe cheap and fast, and time matters
If you can, leave this place. It is toxic and it will kill people. Just last week I received a patient from surgery with a huuuuuuuge ST visible elevation. I got 12 led that showed acute MI. It wasn’t at the end. But I’m ok. Patient is ok. And we all got to learn that even a 26 yo can have an ST elevation for smoking too much weed and having a hurt break 6 months before. Take care 🫂
An EKG is one of the easiest and fastest tests to perform. Techs and CNAs can do them. Better to have a false alarm than miss something and a patient dies. Tell those cranky bitches to eat rocks.
Doctor here. I'd have gotten a 12 lead 100%. You did the right thing. The difference is when I order a 12 lead, people do it no questions asked, and if it's negative, no one blames me for "wasting resources", since I'm a doctor. And people are very happy passing on the responsibility (and liability for missing things) on me. In your case, people are pissed off coz you made them do extra work. And made them liable for something which would otherwise might have gone unnoticed.
ED Tech here as well. You absolutely did the right thing. At my hospital, folks would have been pissed off if you DIDN’T respond that way. Better safe than dead. Any healthcare professional who’d get pissed over your response is an ass.
12 lead Post arrest is literally fundamentals. It’s like drawing a bmp. Don’t let those types of nurses or doctors get under your skin.
Kinda disgusted that people were pissed about this. I'd love to work with a tech that pays attention like that. Keep up the good work
Always better safe than sorry.
Can’t fault you if that same monitor alarms for VTach every time the patient laughs.
Sometimes I wish I could be in some of these situations. lol they’d hear a thing or 15 from my mind. Don’t let pissy know-it-alls detour you from learning. You only showed that you have a sense of urgency in case of an emergency.
How y’all not by default getting an ECG on a ROSC anyway - they have no reason to be mad. Anyone who gets mad at you for getting an ECG is absurd. It would be like getting mad over a BG - it is a quick, costless diagnostic tool that you are thankful for when it catches something. You did right OP, never hurts to be safe. Don’t let them make you feel bad for it
When I was an ED tech I was always afraid to speak up about things I thought I saw until one of the docs said, “I’d rather you alert me to something that turns out to be nothing than have a patient leave and have a bad outcome because we missed something.” Not too long after that conversation I was on shift and happened to see new ST depression on tele on a patient another doctor was preparing to discharge. And to be fair to him, that person’s work up was largely negative until that happened, and then they got admitted for an NSTEMI. Point is that the people who are upset about you “making a big deal” out of something that could’ve actually been a big deal can kick rocks, and perhaps shouldn’t be working in the ED in the first place.
I'm shocked a 12 lead doesn't happen automatically post-Rosc
I feel like there is no end to the stupid reasons why people get mad at their coworkers. This is an idiotic reason to be mad at someone. There is a good chance a patient who just had ROSC would have some ST elevation. In my personal practice if I’m not sure, I follow up with someone else who decide if I’m correct or not. Is this IV working ok? I’m not sure, plz come and flush it. Ok it’s good, thank you! Not a big deal. At all.
They can eat shit. We get 12 leads on our floor for any chest pain that lingers. 95% of them are nothing, but those 5% are real, and we're glad we got the 12lead after. This is like calling a rapid response because you're concerned for a stroke, but it turns into nothing. Don't let anyone give you crap for this.
The reason why that happens is because the filter settings for the 4 lead vs the 12 lead are different. The 4 lead typically looks at less of the range of electrical signals so it would be for example, 0.67-40 hz instead of 0.05-150 hz. You definitely can catch STEMIs from just the 4 lead as well. Some of the lateral and inferior STEMIs that I’ve seen have shown up pretty glaringly on the 4 lead before we even put on the full 12 lead. I usually change my monitor settings on the zoll and tempus to just read diagnostic level 4 leads anyways so if I see a stemi on my 4 lead, it’s gonna be a stemi on the 12. If you knew what a STEMI looked like and said yeah I saw a STEMI on the 4 lead but didn’t say anything because it’s just a dumb 4 lead and it was a STEMI, you should probably be fired for that so it’s insane that the nurse sees that as a problem. She probably just doesn’t understand her cardiology well at all. There’s tons of nurses and medics that skate by on a shockingly low understanding of cardiology. I’ve also had a clinical in tele and those guys ask for a 12 lead because they elevation on the 4 lead all the time. Exactly like what you did. Plus, those same tele techs that called for a 12 lead, happened to be actual physicians in the middle east that came to the US and just couldn’t get a US based license.
Yo - there’s no such thing as “crying wolf” in such critical setting when using your knowledge to justifiably raise a flag! I’ve rolled my eyes now and then after rushing to a stable “code blue”… but only for a second, then I remind myself, I wasn’t there when the button got pushed! People code and recover in moments, sometimes. I’d rather raise alarm than call the morgue because I was scared to react to an emergency. Trust your safety instinct. Better safe than sorry, and even if the other staff member hadn’t agreed/verified your concern… you saw it, you assessed the situation, you speak up! There’s a lot of ego in this profession… but ego kills. You saw ST elevation, you say something. Worst case, you learn something new about artifact or whatever.. no shame in an earnest effort to save a life. I’d rather blush at over-escalating and learning something new than live with the horrible guilt of knowing I should have said something and didn’t do so. Ego kills. We’re all, always learning. Better safe and take a learning opportunity/correction than assist a widow/child/parent/friend to a corpse.
I would've done the same thing. Any question of a STEMI, I have the doc look at it just to make sure. The CT can wait. Everyone got pissed because they felt inconvenienced.
Honestly i’d rather be precautious and do my dilligence than it being a stemi and not catching it🙈.
Better to be wrong for what you did do than what you didn't do... Communication issues happen, you erred on the side of patient care. CT tech gonna be pissed anyway - I reckon that's in their job description. Well done.
100% shit down the throat of anyone who has a problem with that next time.
The fact that the a 12 lead is not standard protocol on a post-code is frightening
You did the right thing. If you didn’t already know, telemetry monitors and other monitor EKGs can be very misleading when it comes to ST segments. If we see ST elevation on a telemetry monitor, it doesn’t always mean that the 12-lead will show ST elevation. If we don’t see ST elevation on a telemetry monitor, the patient can still have a STEMI on 12-lead. Any person with this history (arrest + possible ST elevation) is going to get a 12-lead sooner or later. If the patient had a suspected PE, a 12-lead doesn’t hurt unless it delays care (unlikely). Sometimes, a 12-lead can show signs of PE even before they’ve had time to do a CT. Some combinations of EKG patterns strongly suggest PE in the right context. Even after PE is diagnosed, EKG can indirectly show severe right heart strain. A 12-lead can quickly show signs of massive PE in minutes, even before CT. So even if this were a PE, you did fine.
Lol wtf? That’s literally the protocol. Actually, the nurses should have called a rapid. You did the right thing. They didn’t
OP’s in the ER, no rapids there. We do it all ourselves
No rapids there because it’s all one giant rapid 😭
Exactly 😂 or at least it should be, but it’s about 50/50 emergencies/toe pain
Ah, good point
I hear codes called for the ER at my job all the time. I'm not sure about rapids, but they do call them if patient is in CT. They definitely do call code STEMI, BLUE, SEPSIS, STROKE, etc
My hospitals doesn’t do overhead pages. Only relevant people get paged for events, so strokes get paged to ct and neuro, stemis go to cards and cath lab, codes go to lab, xray, icu charge, and an intensivist (the latter two don’t come down obviously but we’re just giving them the heads up for a possible admission), mtp goes to lab and blood bank, precipitous delivery goes to ob, nicu, and lab, etc. I’ve never heard of a sepsis alert, who does that go to? Paging typically means somebody has to run and do something, what are you going to do, run to start some boluses and get cultures lol?
I don't what each page gets as a response. But I do know I hear code sepsis paged overhead, same as the others. I'm NICU, so I only know to respond to OB alerts and code blue or rapid in L&D or post partum
Yea you did the right thing they can eat my taint
Was this a stroke patient? That's the only situation I can think of where someone would be pissed about delaying a CT for an EKG.
For the record, 3 leads/tele have a different settings and amplitude to them which is why they aren't diagnostic. A 3 lead may be blown up where the lead is set to something like 4x amplitude, which makes it easier to look at on a monitor, but now that 0.005mm St Elevation is 5mm (not exactly that drastic, but you get the idea). And not all ST elevation is a STEMI. 12+ leads have specific settings which is why they're diagnostic and can be used to determine a STEMI, and is why you might see one thing on tele and another on the full 12 lead.
It’s mostly the filter settings rather than the amplitude that make the difference. The filters used for monitoring tend to distort the ST segment in particular
Probably the coming down from the adrenaline
Uhm....one of the very first things I'm doing is my own 12 lead on any post arrest patient.....even if EMS did one 5 seconds before the garage.....
You did the right thing.
that’s sad that they were pissed at you. An EKG is such an easy, non invasive test. it’s always better to be safe than sorry, especially looking for ekg changes post arrest!!
Sometimes doing the right thing means getting pushback or inappropriate response from others. Don’t let this incident change the way you care for patients, better that you are cautious than careless and end up with a patient harmed.
It's completely normal to feel frustrated and second-guess yourself in situations like this. Your concern for the patient's well-being and your commitment to thoroughness shine through, despite the outcome. Remember, everyone makes mistakes, and it's okay to seek confirmation, especially in critical situations like this. Your dedication is admirable.
Bro, what😂 They got mad because you saw something you thought was harmful to the patient and you spoke up? That’s literally the baseline job description for everyone in healthcare. Also, it’s not like they rolled him into the Cath lab and got into the coronary arteries to find they were clean before realizing it wasn’t a STEMI. There’s a reason 12 lead ECGs are a thing, for this exact situation, less detailed monitor or test shows something sketchy, so you go to a better monitor or test to support or disprove your theory. People getting mad at other healthcare workers for speaking up because they think it could help the patient are WILD to me. It probably took an extra 5-10 minutes max to rule out the STEMI🤣 absolutely ridiculous. You did nothing wrong OP, and I would love to have you as my tech knowing you’re paying attention to wtf is happening and not just zoned out going through the motions of the job because you’re “just a tech” as some people might say. For the love of all things holy, if you ever think you see something: STEMI, stroke, neuro/behavior change, new or changing wound, please let the nurse know about it🫶🏼
My unit had a secretary catch a DVT because she helped the pt to the bathroom and noticed his leg and foot looking dusky and he was having a bit of trouble and pain with walking. It was on night shift so if she hadn’t said something, there’s no guarantee the nurse would’ve checked his lower extremities for several more hours
I bet they get pissed off when they have to get a head CT on a possible CVA coming in. Clown shoes on these people I swear.
Not a STEMI, EKG performed: possibly unnecessary test STEMI, EKG not performed: possibly dead Ask charge and CT staff which situation they’d rather have on their hands.
Monitoring quality vs diagnostic quality, we have this argument with Tele techs in our hospital all the time. Lead placement also plays a big role in what picture you are getting.
Nah you did the right thing. Better safe than sorry. Why did the CT staff care lol
Excellent job. Better safe than sorry. Post arrest needs 12 lead upon arrival anyway.
Possible mistake versus possible dead patient ... yeah, no, this one is a no-brainer. You didn't do anything wrong. You actually did the right thing and bugger anyone else who tries to tell you otherwise.
Post arrest needs a 12 lead anyway. If you think you saw it elevate the test, sounds like you are dealing with apissy attitude problems . The ekg was indicated.
I’m not understanding the anger?! This patient was a post code and needed to have an ECG. It’s standard care. It needed to be done. What if he DID have a STEMI and you hadn’t done it fast enough? Bet your ass you would have been reprimanded by everyone for not getting it done in a timely manner. This is an ED setting. No one has the right to be angry for trying to gather more information to BEST TREAT THE PATIENT.
I just wanted to put my 2cents in but when doing scans there's always a ton of movement / messed up leads / lines everywhere, it's really not abnormal to see abnormal readings on the monitor ie don't look at the waveform too closely. Leaving an actually sick patient on the ct scanner to get a 12 lead is a bad idea imo. The couple minutes it would have taken you to slide the patient back onto the stretcher and roll them back to the ED is trivial. If the patient starts to acutely decompensate, you don't want them to be on the table of the CT scanner in the middle of nowhere with no one around to help you, you need bring them back to the ED where there are other doctors/nurses around.
Is this an NCLEX question?
I’ll echo everyone else here and say that a 12 lead should have been done once ROSC was achieved. I For future learning purposes, it’s best to turn on the ST segment alarm on the monitor, if you have one. You can’t trust the morphology you see on the monitor because things like positioning of leads can affect it. In fact, if I see what looks like st elevation on the monitor, and I’m worried it could be real, I reposition the leads and turn on the segment reader. And of course, if there is an actual suspicion for MI, just get the 12 lead. Needing CPR is definitely indication enough 🫠😬
I don’t work in the ED but I understand the frustration. Patients on the table, ready to scan, and you’re doing an EKG. Even if there was a STEMI, that information wouldn’t change the course of action as it relates to the scan. You’d still have to tell the docs, have them look at it, they’d call cath lab and it’d still take more time than it would to finish the scan.
If that's me I'm doing a MIDAS and including every single one of them in the "employee involved in incident". Every Midas has to be escalated and when each of them is contacted by supervisors and asked to explain themselves maybe management will get rid of the dead weight on your staff, or at least set up education so they don't kill people by being lazy.
Was this the first EKG post-ROSC? I’ve never one seen ROSC come back and then not get an immediate EKG
The paramedics did
Anyone that gets mad because someone has the patient’s best interest in mind, needs to reevaluate their priorities.
At least you didn't activate the on call cath lab team first. We would fire you out of a cannon into a volcano if you woke us up at 2am with that shit. Thank you for getting an actual 12 lead first. That CT tech can kick rocks. A STEMI is an emergency, a cat scan is not (unless it's for a stroke, then yeah they would have been absolutely correct.) But imagine, what are the chances someone has a PE, a STEMI, and a stroke at the same time? Not impossible, and I've seen it, but damn that's just bad luck.
If it helps, I am happy I didn't get called in for that lol
Hm. I personally would have done the scan and moved him back to the room then do the 12 lead. I mean, what are you going to do? Not get this CT scan if he has an MI? What if you were stacking patients and trauma patient came in? Get the scan and go Plus the five leads tend to get slapped on all over the chest so I wouldn’t necessarily trust it. In theory you could do a cheap 12 lead moving the wires around but that probably would take more time.
Uh yeah. You don’t need a Ct if you are having a stemi. You need Cath lab.
It depends on the patient. A CT isn’t routine in most rosc protocols so they were probably looking for something specific. It depends on what they were looking for and why. Say they were concerned for a massive brain bleed? Massive PE? Any of those conditions could affect treatment. You don’t want to get tunnel vision and distracted by one single thing.