Saturday, October 20, 2007

More Bread and Butter

After working all day last week, my mom called at 2am.
She's frail, 83 yrs old and had an ACB this summer. After 3 months in rehab, she had been back at her retirement center for 5 days.
"I'm just weak" she said. (We all love those octogenarians who are "just weak")
I told her to push her "I've fallen and I can't get up" button and I'd meet her at the ER.
When I got there, I didn't understand why there was so much activity around her...then I saw her EKG! I post it since I thought it was a great tracing.
The cardiologist came in and put a temp pacer in her (they wouldn't let me do it....I LOVE to do those), and she got a permanent pacer a couple of days later.
She's back at the rehab and doing well.
No HIPAA concerns, her name is removed, Mom thinks the internet is a bunch of tubes, I have power of attorney, and all of her friends are dead.


  1. No HIPAA concerns, her name is removed, Mom thinks the internet is a bunch of tubes, I have power of attorney, and all of her friends are dead.


    You're gonna fit right in over here. ;-)

    PS: My verification word was "lurtab". That's just creepy.

  2. I laughed *so* hard at the HIPAA bit, especially "Mom thinks the internet is a bunch of tubes." I called my nerdy (like me) roommate over to have a look, and she did the same.
    Oh, and welcome :)

  3. i'm just a simple car-crash physician but i think that's slow.

  4. I love you guys! And erdoc85, it appears that you are an excellent addition to the the great cast of characters already writing this blog.

    I'm not a medical professional, just an interested party, so I come here to learn and laugh(not always or necessarily in that order).

  5. I just took an EKG class-this is heart block, right? 2nd Degree, type I? Am I close?

    I got a kick out of the HIPAA stuff too!

  6. looks like 3rd degree/complete block to me. the ER doc in me simply looked at it and said, 'way too slow'. erdoc85? you of wondrous cardiac knowledge? can you do a little teaching?

  7. 911: you are correct, sir. This is 3rd degree block. The ventricular escape isn't completely regular in this snapshop.

    anon: the thing that distinguishes this from Mobitz type II 2nd degree block and makes it 3rd degree block is the fact that there is no AV conduction anywhere. In other words, no P wave ever leads to a QRS.

    Glad the HIPAA statement is being taken in the spirit intended.

  8. guess that helps explain the weakness!

    Fantabulous EKG by the way....

  9. I hope your mother is feeling better--and I'll keep her in my prayers.

  10. A fine edition indeed. I think you're probably going to be a cross between 911Doc and A more "tactful" version of Etotheipi," but who knows maybe you're just shrodingers cat, DRX and the oldfart all mixed together. Well, whoever you are, it's been good reading your posts.

  11. Got a great laugh out of the "internet is a bunch of tubes" comment. Glad to have you aboard. Our cardiologists get upset when we place or try to place temp transvenous pacers, because we're honing in on their business, plus, most people can be bridged with transcutaneous. I have one partner that just goes right in and puts a transvenous in everyone and gets in trouble.


  12. Your mom sounds like mine. When I told her she needed to get on the internet, her reply was that she liked pantyhose much better.

  13. solid 1st post... except for that chart with the squiggly things - i don't get it.

    Whenever some real doctor shows me an EKG, I know I'm supposed to be impressed, so I just look at it, raise my eyebrows, and go "Whoa! Not good!". They think I'm a genius.

    Your last sentence is a gem. glad to have you on board.


  14. I hope EMS paced this as well!

  15. brn: I passed your sentiments along to Mom. She appreciated it (as do I).

    lynn: Loved the panty hose!

    etotheipi: LOL. Thanks.

    Fiz: EMS had the external pads on her, but they never turned it on since she was mentating pretty well and had an acceptable blood pressure. I thought that was reasonable. Ended up being one of my favorite medics that picked her up. He feared that I'd be pissed that he didn't pace her externally, but I thought he did well.

    I'm not a huge fan of the external devices. In my experience, it seems like I have to turn the mA up so high to get "capture" that the patient doesn't tolerate them, or I have to drug the patient to near hypotension to tolerate the thing. It's always worth a try, but I find that it doesn't work well often.

    I have a great story about my intern year and my first patient as a doctor that I'll share sometime.

  16. Makes sense about the EMS pacing... I kinda assumed that her BP would be low just based on the rate but I guess that is not always so.

    About the rhythm, are we sure it is a 3rd degree? I would want to see a longer strip but it looks like there is a fairly consistent PRI even though it is quite long...

  17. fiz: yes, it's 3rd degree. If there were conduction from the atria, the QRS would be narrow. Since the QRS is wide, it tells you that it's either a ventricular ectopic beat, or a bundle branch block.

    In 3rd degree block, it's not unusual to see a "pattern" since the atrial beats are regular and often the ventricular beats are regular as well. But they're not connected.

    It's often confusing.

    As a funny aside, the on call cardiologist read it as 3rd degree block, Mom's cardiologist read it as 3rd degree block, but the "official reading" (the one that we'll be billed for) from the internist on call to read the day's tracings was "Afib with Slow Ventricular Response"! There's no way!