I don't agree about trashing the ECG machine. In our small practice we have
a good one which is accessible and easy to use, hence we tend to use it
fairly readily. In the last month, I can think of 3 occasions when this has
changed management:
a). I had a 39 year old fit non-smoker come up as an extra at evening
surgery with a mild recurrence of yesterday's chest pain, which he had
worked through. A bit anxious cos of family history, so I did an ECG for
reassurance, tho careful history suggested NOT ischaemic - the ECG showed
anterior ischaemia, admitted to hosp(took some persuading!) , and enzymes
confirmed infarction. Point is that if I didn't have the ECG, my clinical
decision would have been to reassure and send home.
b). One partner had a rather unfit 40 year old asking for advice on how to
start taking exercise. Totally asymptomatic. Craig took his pulse - in the
50s - and did an ECG which showed 2 to1 heart block. The guy had a pacemaker
fitted within the week (NHS!). Point here is that Craig doubted if he would
have referred a guy with no symptoms and a rather slow pulse up to hospital
for an ECG; it was only the ready accessibility that led him to do one as
part of the consultation.
c). 'tother partner, Judith, had a lady with recurrent
palpitations,(clinically fairly trivial) say in consultation, "they're
happening now" round to practice nurse for the ECG which showed multiple
VPB's with a W-P-W picture.
When our patient group bought us a new Heartstream defib (about which I
can't enthuse enough as it is light, reliable, maintenance free and
doctor-proof), we also got a light weight portable ECG for our duty doctor
to use . At the w/e Craig had a 50 year old male ( with a past history of
ASD repair), complain of an irregular pulse, ECG showed atrial fib, and
management discussed with cardiac registrar by phone, saved a lot of hassle
for the patient.
-----Original Message-----
From: Stephen Miell <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 22 April 1998 22:44
Subject: Re: Dream on..........
>Get yourself a spirometer and trash the ECG unless you regularly
thrombolyse
>patients before the ambulance arrives.
>
>Stephen Miell
>Burnham Medical Centre, tel: 01278 795445
>Email: [log in to unmask]
>
>
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