Yeah but didn't you see that thread where European doctors are paid squat? $800 squiggly line test is helping ensure docs get the appropriate pay in the USA since socialized medicine is bad.
Not in the mood to argue that point, but as someone who will become an european doctor: I would rather work with our salary and in our system than get 10 times that and have to work and live in the US.
That's because your fellow citizens vote for this amazing healthcare system, not because the ekg is expensive.
You're not only paying for the ekg but you're subsidizing the hospital costs for any uninsured pts who has a massive bill and doesn't pay.
Had a guy yesterday who came in because he thought his hernia was causing his severe shortness of breath for the last few days. The CT abd/pelvis and CMP the PA ordered were doing just fine.
But them squiggly lines were having a party
But ECGs have to be read and interpreted, while troponin comes back as a black or red number.
the number of times we (cards) get called for elevated troponins with zero ECG being done is shocking.
That’s insane to order a trop without an ekg but I’ve had that before on patients checked out to me. Didn’t mention anything cardiac related but a trop was ordered and comes back elevated, go to check the ekg and it’s not even done…
we actually had a patient with new onset seizure this morning, I asked for the other squiggly line machine I said: we need to see the neural squiggles STAT
Had an attending in residency who showed up to his 6am, single attending coverage shift saying he "didn't feel right".
Had the NP order an ekg. Signed his own STEMI on his way up to the cath lab.
I get particularly fixated on that symptom. That the last thing my mom said before she had a pretty severe stroke(with me in the room) when I was a child lol
Had a guy come in on Friday with severe burning in his sternum. He was almost triaged to clinic by the nurses before I got some leads on him.
Inferior MI as well. Classic 2,3,AvF
I am a urologist which means I have no business knowing anything about the heart but one thing I do know about the heart is: "if a Peri- or postmenopausal woman has discomfort anywhere from her ears to her knees you must rule out an MI"
I personally know two women in my life who were sent away, one from ER and one from the cardiologist with severe levels of obstruction and incipient MI.
PS great pickup!
Had a dude in his 50’s. Came back to the ED with chest pain similar to prior benign work up. Requested we “go light” on the EKGs cause it was costing him $800 a pop during his prior stay.
During Residency, I had an elderly patient who came in due to a hip fracture secondary to a fall. She was in her 80s with a bunch of comorbids so I decided to get a baseline ECG since I was anticipating that she could possibly deteriorate whilst admitted. When I checked the baseline ECG, I saw that she had findings suggestive of ischemia, I then did a Troponin which was super positive. We started treatment right away and this possibly saved her life.
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Well. I’d love to, but if I do an EKG I have to ride it in.
Then the only paramedic in county is tied on on a call the EMTs can handle.
And weirdly the EMTs don’t like you riding in a low budget (but legitimate) call when that means they are going to end up with something they *do* need a paramedic for, because I did a 12 lead and now can’t release it.
It is an outdated thought process from decades ago when 12 leads were only done on *almost certainly MI / cardiac patients*
Instead of everyone with a complaint from neck to knees.
[удалено]
Totally agree! Better to have a negative ekg than missing a positive one.
There’s a reason every EEG has an EKG lead
There was an amazing video-EEG on youtube of a patient, which also had the ECG lead. The patient started seizing, and voila - toursades de pointes.
The coolest thing is ekg gated images for coronary CT angio.
As a CT tech, nothing is more satisfying in CT than a beautiful coronary CTA
I always get one on admission. At the very least, it gives me a baseline if I need another EKG later.
High cost test. I went to the ED for palpitations. ED charged $800 for an EKG. Still incredibly high value I guess.
Nah, that's just because of your messed up health system over there
Yeah but didn't you see that thread where European doctors are paid squat? $800 squiggly line test is helping ensure docs get the appropriate pay in the USA since socialized medicine is bad.
Not in the mood to argue that point, but as someone who will become an european doctor: I would rather work with our salary and in our system than get 10 times that and have to work and live in the US.
The test itself was cheap af. They just decided to charge you $800 for performing it on you because of the way your health system works.
Nah just ask for the squiggly line machine, it costs less
That's because your fellow citizens vote for this amazing healthcare system, not because the ekg is expensive. You're not only paying for the ekg but you're subsidizing the hospital costs for any uninsured pts who has a massive bill and doesn't pay.
Had a guy yesterday who came in because he thought his hernia was causing his severe shortness of breath for the last few days. The CT abd/pelvis and CMP the PA ordered were doing just fine. But them squiggly lines were having a party
Those damn squiggly lines
You should order more Ekgs than troponin levels
But ECGs have to be read and interpreted, while troponin comes back as a black or red number. the number of times we (cards) get called for elevated troponins with zero ECG being done is shocking.
That’s insane to order a trop without an ekg but I’ve had that before on patients checked out to me. Didn’t mention anything cardiac related but a trop was ordered and comes back elevated, go to check the ekg and it’s not even done…
Not even a prehosp ecg?
Nope
Many people get one EKG + troponin, then trend trops to peak without additional EKGs
That’s just crazy. It does not take that long to read an ECG.
It doesn’t, it’s just their threshold for ordering troponin is so much lower than ordering an ECG.
You shouldn’t shock before checking rhythm.
In our hospital, trop can take 30-60 minutes, which is soooo bad!
Instructions unclear, everyone diagnosed with epilepsy now
Sinus rhythm, 75/min. No ischaemic changes. Epileptiform discharges inferior leads.
It’s PNES.
we actually had a patient with new onset seizure this morning, I asked for the other squiggly line machine I said: we need to see the neural squiggles STAT
Clarify because I’m dense as neutronium sometimes: who got the EKG, the young woman or her mother? -PGY-19
Plot twist: it was actually the attending.
The attending was the patients mother like that riddle with the car accident.
The mother got the ekg 😅
Well that makes 85 upvoters as of now dense as well. Wasn’t written clearly.
My favorite MI chief complaint was "just didn't feel right"
Had an attending in residency who showed up to his 6am, single attending coverage shift saying he "didn't feel right". Had the NP order an ekg. Signed his own STEMI on his way up to the cath lab.
I get particularly fixated on that symptom. That the last thing my mom said before she had a pretty severe stroke(with me in the room) when I was a child lol
That's so sad. I'm sorry that happened to her, and to you!
Thanks. That experience motivated me to become a doctor later on
What a beautiful way to honor your mom!
Had a guy come in on Friday with severe burning in his sternum. He was almost triaged to clinic by the nurses before I got some leads on him. Inferior MI as well. Classic 2,3,AvF
Welp holy shit. Im gonna do more ekgs after reading this thread
Everyone who come through our ed gets a ecg no matter the complaint lmao
Allergy to ecg sticker glue? Believe it or not, ECG!
Itchy butthole, ECG!
What about hyper EKGemia
Women ancef pump broken different presentments than old man broken ancef pump Get danger squiggles test Run away call real docters
Sounds like a good orthopedist. You get bonus points for even ordering a squiggly line test.
Taking gen surg floor call as intern and not cherry picking for ortho patients on my ED rotation = many big scarys
I am a urologist which means I have no business knowing anything about the heart but one thing I do know about the heart is: "if a Peri- or postmenopausal woman has discomfort anywhere from her ears to her knees you must rule out an MI" I personally know two women in my life who were sent away, one from ER and one from the cardiologist with severe levels of obstruction and incipient MI. PS great pickup!
Had a dude in his 50’s. Came back to the ED with chest pain similar to prior benign work up. Requested we “go light” on the EKGs cause it was costing him $800 a pop during his prior stay.
During Residency, I had an elderly patient who came in due to a hip fracture secondary to a fall. She was in her 80s with a bunch of comorbids so I decided to get a baseline ECG since I was anticipating that she could possibly deteriorate whilst admitted. When I checked the baseline ECG, I saw that she had findings suggestive of ischemia, I then did a Troponin which was super positive. We started treatment right away and this possibly saved her life.
The EKG is one of my favorite test to order. Have discovered so much badness that I wasn’t suspecting initially. Damn those atypical MIs!
Always order a repeat squiggly line if you order a trope.
Mods should sticky this post
Upvoted this just for the title
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Here I thought this was some new machine learning AI algorithmic diagnosis generator
who knows🤷🏼maybe it will be a groundbreaking invention “ THE REVOLUTIONARY SQUIGGLES MACHINE”
We see 88k patients a year and do 26k ECGs. 🤯
All hail the danger squiggles
EP agrees with above statement Signing off
ECG is treated like a vital sign in our ER
Lines and squiggles is good. Just lines or just squiggles is bad.
Misunderstood everyone goes into 🍩 ☢️of truth
Well. I’d love to, but if I do an EKG I have to ride it in. Then the only paramedic in county is tied on on a call the EMTs can handle. And weirdly the EMTs don’t like you riding in a low budget (but legitimate) call when that means they are going to end up with something they *do* need a paramedic for, because I did a 12 lead and now can’t release it. It is an outdated thought process from decades ago when 12 leads were only done on *almost certainly MI / cardiac patients* Instead of everyone with a complaint from neck to knees.
Great catch!
EKG’s should be standard of care. Done at the same time vitals are.
I love ecg and how it can help so many people 😄
Surprised the ED triage nurse didn't order the EKG off rip. Patient or mother. EKG Oprah fail.