An ER physician cancelled my cath lab activation the other day. No, I didn’t save the 12-lead. I should have, and maybe I will try to find it once I go back to work.
It was a male in his mid-forties. He had just gotten back home from a walk around the neighborhood, and couldn’t catch his breath, and kept sweating. It’s been a little warm around here for the past few days, but not that warm.
So, duh, he’s having an MI.
For some reason, the interpretation didn’t pick it up. He was in a sinus bradycardia with an (apparently new) left bundle branch block. He met all the Sgarbossa criteria. He was hypotensive. His skin was diaphoretic, even though it was 74 degrees outside.
We transmitted the ECG to the hospital, and I called the cath lab number on my phone, like we always do from the field. After loading up in the ambulance, I called the hospital to give them my ETA.
That’s when I was told my activation was cancelled.
“The ER doc.
It turns out that the nurse who receives the ECGs we transmit shows them to a physician. Not a specific physician, mind you, just any physician he or she can find in the hallway. And this time the physician cancelled my cath lab activation.
Wait for it.
Because my 12-lead didn’t say “STEMI” on the top.
This jackass in a white coat cancelled my cath lab activation because the interpretive statement didn’t recognize an MI in the presence of a left bundle branch block. This isn’t a case of a false activation, either. I took the 12-lead upstairs to the cath lab to show a cardiologist friend of mine.
“Where’s this patient?” he asked me.
“Downstairs in the ED.”
“What the hell for? Why isn’t this patient up here?”
“Ask the jack wagon in Trauma 4. I activated you, but jack wagon cancelled the activation.”
Where was the patient?
In Trauma room 4. Twenty minutes after we walked in the doors, he arrested. He went into v-tach and tried to die. He was resuscitated, but now, several days later, he is upstairs in the ICU on a ventilator, with a balloon pump hooked up to him.
Because some jackass doctor can’t interpret 12-leads.