Eep… ECGs

Image via healthtap.com.

ECGs terrify me.

Not the getting them part, although the the prospect of exposing my bosom to a stranger is not overwhelmingly thrilling.

I hate reading them.

Although things are getting better.

I learned to take ECGs when I was in Nuc Med, as we need to do both 3 lead and 12 lead ECGs for some of the tests.  That was fine.  I just knew what looked super abnormal to correct lead arrangements.

In first year medicine, we did a cardiology block that was rather intense.  Again, basics of ECGs were covered, but beyond that, not so much.

Then, I kind of forgot about ECGs until clerkship…

Where I went to med school, Friday mornings on Internal Medicine consisted of a kind of torture that begets old school stereotypical medicine… ECG rounds.  Yes, the cardiologists somewhat ironically always provided Tim Hortons coffee, muffins and donuts, so free food was a win.  But, that was countered by the humiliation that came with ECG rounds.

Image from ems12lead.com.

Basically, the residents covering the CCU would hoard ECGs from the week that seemed “interesting” (some of them, depending on who the people choosing the ECG, were moreso cruel).    Then, on Friday morning, they would be displayed one by one on a projector and the clinical clerks would be picked one by one to interpret the ECG and answer questions.  Sometimes the junior residents would get picked too, especially if things were difficult.

This is somewhat relevant to the adventures in ECG rounds… I wish I had referred to the diagram. I would probably be folding jeans at the Gap. But much more well rested. Image from doctorcartoon.blogspot.com.

It was horrific as a med student.  Because you would know it was coming all week.

Some people were nice about it.  They taught around your mistakes and gave some awesome tips.  Others picked and picked.

I think that colored my perspective of ECGs.

But I did learn, yet I doubted what I did learn.

By the time I started Cardiology this time around, I feel as if I could identify obvious ST elevation MIs and a few arrhythmias.

Image from leadsbank.co.uk.

I feel like the last week of call, minus the endurance sleep deprivation test has taught me a bunch about the management of cardiac patients by osmosis and by fire.

But, when I walked into teaching rounds this morning and a cardiologist was sitting there was an ECG up on the screen, I nearly pooped myself.

I know, that sounds dramatic.  But I had horrific memories of the torture of ECG rounds.

So, we, the three off-service residents and two med students, sat down across from this cardiologist and the ECG.  Nobody else looked as uneasy as I felt.  He chatted and got us to introduce ourselves (in my mind, clearly to belittle us by name).

He asked who would like to take the first one.

I had an out of body experience in which I volunteered.

I think it was a defense mechanism. I remembered that people who went first usually go the easier ECGs and sometimes were treated a bit better.  It was worth a shot.

I totally knew what was going on in the ECG… First degree AV block.

Image from gem.fi.

No face eating.

But, it was early.

And yet everyone had a turn.  And sometimes it took a while to get through an ECG and sometimes people made mistakes, but the cardiologist was helpful and pleasant.

We all started helping each other after we all had a turn.

It was quite possibly the most useful session on ECGs ever.  And not the first one where the instructor was nice, but one of the few I have been in (and those aren’t the ones I have generally remembered).

ECGs are such a bizarre thing to get the hang of (this from someone who did Nuclear Medicine sometimes called “Unclear” Medicine).  Little electrical tracings can say so much and make such a difference in management.

Maybe they aren’t quite as scary as I originally thought.

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