The how not to series; Episode 1, EKG and others
The past two weeks had been really tiring, had my two week rotation in the Cardiology department, I know two weeks aren't enough; but hey you gotta make use of the most out there and that's what I tried to do.
Basics of cardiology rely on the EKG, clinical presentation, any significant past history and co-morbidity + risk factors. Reading a basic EKG, the one which we all read in physiology textbook, the P wave, the QRS complex and the lonely T wave, it was easy enough but just imagine you're standing there in the cardiology emergency and there's a sudden influx of 7-8 people along with a patient who's screaming and shouting, forget the fact that you're a doctor, almost everyone who's new to the place would have sweat all over their forehead and the first few times P, QRS and T, you'd be like what the fuck do I do now. But thankfully the residents are always there to deal with anything and everything.
I wanted to properly learn and interpret the EKG, yeah it's ECG as per the usual textbooks but let's stick to traditions and call it EKG.
A couple of days ago I was having a conversation with a colleague about how EKGs are just confusing sometimes, and afterwards I thought why shouldn't I write something about it but there is so much about it already, books and videos, articles and what not. But hang on, what about
"How not to learn EKG, a first hand experience of an anxiety fueled and stress overloaded young doctor"
And from there I thought why not start the how not to series on this blog.
The first thing, this is important.
1) Just relax, It was my second day in the emergency and it was pretty easy to read my stress levels, they were off the charts. A really nice resident was in the emergency at that time and she said, why are you so stressed and worried, just relax. It took me a couple of days to develop the ability to relax. The more you are stressed, the more likely it is that you'll make a mistake.
2) You don't learn to interpret EKGs overnight, it takes time and you gotta be able to give yourself the time and space to learn, in the process of learning you are bound to make mistakes so always have the ability to take a step back and correct yourself.
3) The residents and consultants are there for a reason, your knowledge cannot be compared to their clinical experience and practical knowledge. You are like a baby taking the first steps, and they're sprinting. Take their help, I have personally experienced that over here a lot of consultants don't even like to even answer a question from a internee, if you find a consultant like that, look for a helpful resident.
4) Never shy away from asking help. Again, its better to walk with support than to repeatedly fall over and over again. You are bound to mistake early repolarization with ST-elevation
5) Always observe keenly. Co-relate your findings on the EKG with the clinical presentation, compare your findings with the findings from the residents. Compare and contrast to make the most critical evaluation of your learning.
6) This is the most important bit, always do a brief but satisfying examination. A lot of people will just look up at the monitors to jot down the vitals but take 2 minutes out for the patient; talk, listen and then touch. It's easy to copy the findings of the residents or consultants but examine the patient, doing so you will be able to differentiate the abnormal from the normal. Plus it makes the patient feel important and you develop a good repo with them.
Basics of cardiology rely on the EKG, clinical presentation, any significant past history and co-morbidity + risk factors. Reading a basic EKG, the one which we all read in physiology textbook, the P wave, the QRS complex and the lonely T wave, it was easy enough but just imagine you're standing there in the cardiology emergency and there's a sudden influx of 7-8 people along with a patient who's screaming and shouting, forget the fact that you're a doctor, almost everyone who's new to the place would have sweat all over their forehead and the first few times P, QRS and T, you'd be like what the fuck do I do now. But thankfully the residents are always there to deal with anything and everything.
I wanted to properly learn and interpret the EKG, yeah it's ECG as per the usual textbooks but let's stick to traditions and call it EKG.
A couple of days ago I was having a conversation with a colleague about how EKGs are just confusing sometimes, and afterwards I thought why shouldn't I write something about it but there is so much about it already, books and videos, articles and what not. But hang on, what about
"How not to learn EKG, a first hand experience of an anxiety fueled and stress overloaded young doctor"
And from there I thought why not start the how not to series on this blog.
The first thing, this is important.
1) Just relax, It was my second day in the emergency and it was pretty easy to read my stress levels, they were off the charts. A really nice resident was in the emergency at that time and she said, why are you so stressed and worried, just relax. It took me a couple of days to develop the ability to relax. The more you are stressed, the more likely it is that you'll make a mistake.
2) You don't learn to interpret EKGs overnight, it takes time and you gotta be able to give yourself the time and space to learn, in the process of learning you are bound to make mistakes so always have the ability to take a step back and correct yourself.
3) The residents and consultants are there for a reason, your knowledge cannot be compared to their clinical experience and practical knowledge. You are like a baby taking the first steps, and they're sprinting. Take their help, I have personally experienced that over here a lot of consultants don't even like to even answer a question from a internee, if you find a consultant like that, look for a helpful resident.
4) Never shy away from asking help. Again, its better to walk with support than to repeatedly fall over and over again. You are bound to mistake early repolarization with ST-elevation
5) Always observe keenly. Co-relate your findings on the EKG with the clinical presentation, compare your findings with the findings from the residents. Compare and contrast to make the most critical evaluation of your learning.
6) This is the most important bit, always do a brief but satisfying examination. A lot of people will just look up at the monitors to jot down the vitals but take 2 minutes out for the patient; talk, listen and then touch. It's easy to copy the findings of the residents or consultants but examine the patient, doing so you will be able to differentiate the abnormal from the normal. Plus it makes the patient feel important and you develop a good repo with them.
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