If you’ve ever wondered what all those leads and sticky dots were doing when placed over a patient in a hospital or in a film then they were probably having their heart monitored. And by monitored, they were probably having some form of ECG (Electrocardiogram . . . with a C, for Cardio. Not EKG, like how the septics spell. ECG!).
ECG’s are a fantastic system used in lots of hospital and pre-hospital environments to help determine cardiological issues and help us determine the correct course of treatment and outcome for the patient.
They measure the electrical output of the heart and we do this by strategically placing several (10 in the UK) sticky dots attached to leads, over the patient’s chest and limbs. And, after the patient remains still, we gain a readout from the Lifepak machine that gives us 12 different views of the heart. This is when we, the clinicians, pretend to know what we’re looking at.
So below, to help anyone who might be in the remote bit interested, I’ve put together a quick Top 10 Do’s and Don’ts of how to ECG . . .
I did an observer shift in Control a while back. I wanted to watch and listen to how calls come in, got triaged, allocated and then managed.
So, sitting with Laffieres*, a Clinical Team Leader, I was able to listen in to a patient call back. They had rung 999 feeling faint and had won themself an Amber response that could see her waiting a long while for an ambulance. London were holding a ridiculous amount of calls and, as usual, only had a finite amount of ambulances to send. So, it was Laffieres’ job to ring the patient back and re-check their clinical status to see if anything had changed and to see if there were any ‘alternatives’ that could be used to help the patient. This was all done using the Manchester Triage System, a quick, more concise generalised system to help clinicians triage a patient’s needs over the phone.
After a short conversation Laffieres concluded the patient did not need an ambulance at all. And, upon receiving the news that they were no longer going to be getting one, the patient’s demeanour changed. One second their voice had been woeful and demure, the next it was harsh, cruel and direct.
“If you don’t send me an ambulance I’ll ring 999 again! And I’ll keep ringing, over and over!”
My jaw had genuinely dropped. I could not believe what I’d just heard. Laffieres laughed.
“We get it all the time mate. Every day, over and over. She’ll call back in a minute, I guarantee”
And she did . . .
London Control Room
“Yep. Admitted he had been a dick and had put the whole thing on, and was genuinely apologetic”
The officer was referring to a patient that, a couple of nights previous, had almost caused a mini riot and forced me to call for ambulance back up over an open mic, as Red 1 . . . for a pseudo fit!
A neighbour let us in to the patient’s flat and led us to where she was lying on the kitchen floor. The poor old girl had simply fallen and not been able to get up, and had subsequently been lying for over six hours.
Now, I don’t have much of a sense of smell. I put this down to constant exposure to horrible smells over time. And thus, when we stepped into the kitchen, the smell of faeces that hit me was like a ton of bricks to my senses.
My god! I thought. That really MUST smell bad if I can smell it.
And to make matters worse – that sneaking, creeping, terrible feeling of awareness started prickling at the back of my neck . . . .
We were going to have to clean her up!!!!
Working on a pre hospital emergency you can be forgiven certain etiquettes in standard procedures. Like intubating a patient whilst they’re on a filthy floor in a corner of a darkened room. But, as long as there is no ‘real’ harm done to the patient then it should be fine . . . shouldn’t it?
I opened the roller clamp on the IV Paracetamol and held the bottle above the patient’s head to watch the flow. But, instead of seeing the drips coming down, I saw the patient’s blood run vertically up the tube toward the bottle!
Ah . . . I thought, this is awkward . . .
Antecubital Fossa (ACF)
I was being ushered into the house by the patient’s immediate family. Their looks of grave concern was matched by their eagerness to get me to the patient as quickly as possible. This sort of behaviour generally makes up your global overview of what is going on and how serious the situation potentially could be.
I therefore decided not to make ice breaking jokes at this particular time and instead, took it as serious as the atmosphere dictated.
Inside were more family members, some of the older women crying. They all ushered me upstairs to where the patient lay on a bed, one hand clutched to his chest, the other wiping tears from his face.