September 5, 2007

Treat the Patient, Not the Monitor

Last week, Peter Canning wrote a great article on his Streetwatch: Notes of a Paramedic blog about a recent call he was on:

Read his Reversals post here.

In this story, he talks about a patient that presented physically one way, but had an ECG reading that pointed in another, more alarming direction. Which is worse: misread a critical patient’s ECG and under treat the patient for a time – or – think a patient is more critical than they are and over treat the patient? While I think there are arguments either way, I would choose the former.

I try to constantly reassess my patients. I work on remembering to pay attention to the suspicions my mind throws at me that lead me to either trust or mistrust a previous finding. It works like this. When a patient presentation doesn’t match up with another sign or symptom, it’s time to restart your assessment and try to come at the patient’s problem from a new direction.

This gives you the opportunity to try manual BP’s more often, recheck your ECG readings, and focus on a different area of your examination. Did you miss something in your history? Redo your SAMPLE and see if the patient forgot to tell you something earlier. Ask the family member up front another round of questions. All of these things may point you in a different direction.

When a patient seems critical and needs aggressive treatment, I’m all for it. A guy who’s pale, sweating like big dog, complaining of chest pain, and showing V-Tach on the monitor is gonna get my attention. But if the monitor is showing apparent V-Tach and the patient is presenting with an infection in other ways (as Peter’s did), then it’s time to check my lead placement, recheck vital signs, and do a 12-lead.