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Noooooo! Please, please no! Make it stop already. Just because the cardiac device manufacturers won't staff enough technicians to care for the expanding population of patients with pacer/AICD devices in a timely fashion doesn't automatically mean us already highly pressured single coverage EPs should take this on our already ever-expanding scope of practice. It is important that we can delegate time consuming specialized tasks like pacemaker interrogation to specially trained personnel. While EP-perfomed pacemaker interrogation may be okay at high-volume centers with lots of cases, practitioners in my environment are only going to have one or two of these cases a year - hardly enough to be comfortable/competent at it or even to be worth purchasing the equipment. There is also an issue of "competence" from a medical-legal standpoint.
I completely agree!
Regarding in-department device interrogation I have found it very helpful with no additional workload or risk and definite benefit to the patient. We have an ‘interrogator’ in our department and the nurse or tech simply uploads data from the device and I get a printed report and a phone call from a device rep to explain the report. At that point I have specific data to relay to the EP cardiologist about their patient’s device which often results in the patient being able to be discharged.
Regarding plastic surgery complications we had a young lady come to our department in cardiac arrest with lidocaine toxicity. She had a lidocaine pump that was infusing lidocaine continuously into thr tissue after breast augmentation. It had malfunctioned and emptied it’s entire reservoir causing toxicity. She was resuscitated with standard ACLS before the cause was clearly identified and she survived. It’s worth keeping these pumps in mind and you may consider asking if the patient has one.
This is somewhat related to the placenta previa discussion.... I agree with Rebecca Bavolek MD and Jess Mason MD that the KB test is not very good and not frequently utilized in the ER. I have become involved in a project to develop a policy for RhoGAM administration. Despite some literature that I have come across advocating for the use of KB testing to quantify the volume of a fetal-maternal hemorrhage to aid in RhoGAM the evidence is very poor. Is anyone aware of any good evidence advocating for KB testing to aid in RhoGAM dosing in traumatic or non-trauma causes of FMH?
fact check ... Dan McCollum's discussion on social psychology was in the February 2018 episode .. not the January 2018
What you do matters.