Location, location, location

Another year, another type of medium for PCR writing, another piece of software.

One thing I’ve noticed at different agencies, no matter how data are gathered, is that the options provided to us for location data never include the truly applicable. For instance, there would be such no-brainer selections as “residence” or “grocery store” or “office” but there are other way more specific locations that generate far more emergency responses that are never listed.

Just to name a few:

  • payphone (by far the most under-appreciated location as far as data collection is concerned)
  • bus stop
  • subway/train station
  • liquor/convenience store
  • shelter
  • rehab
  • homeless encampment
  • gas station
  • airport
  • doctors’ office/clinic/dialysis center
  • sidewalk
  • someone’s front lawn
  • someone’s back yard
  • someone’s doorway
  • in a car
  • on a bus
  • parking lot

Can you think of any others?

12-lead placement is simple, so why do so many people fuck it up?

I see incorrect lead placements all the time, especially precordial leads. I see this in prehopsital settings. I see this at the EDs. Some days, it seems like no one on Earth knows how to do it correctly.

The other day, some idiot medic had the gall to tell me that my placement of V1 was too high. I ran my fingers down the normal-sized patient’s ribs, counting out 4 intercostal spaces along his sternum, just to make a point. This idiot removed all the leads and put them on incorrectly anyway, without any evidence he physically touched and counted any intercostal spaces.

I don’t understand it. There are not many different ways to do it. Entire diagrams of lead placement are printed in protocols and textbooks, in color, in black and white, superimposed on ribcages, described in detail – you just have to follow it. Endless pages of images of proper lead placement are searchable on Google if one simply bothered. In fact, for this post, it took me HOURS on Google just to find 3 or 4 images of incorrect precordial lead placement.

So what the fuck? Why can’t people put these leads on right?

Limb leads go on limbs. Not the torso.

Precordial leads go like this:

OBHG Education Subcommittee
OBHG Education Subcommittee

Another view:

Wikipedia/Mikael Häggström
Wikipedia/Mikael Häggström

This image shows why we do precordial leads a certain way:

precord_view

Another image:

EKG_leads
Wikipedia/Npatchett

Another one:

fab1b553147852918fac8ea5423017ed

One more:

07-ECG-Anatomy-LITFL

Therefore, with axis in mind, this is absolute bullshit:

pleadp

So is this:

AP Photo File/Thomas Kienzle
AP Photo File/Thomas Kienzle

As is this:

ems12lead.com
ems12lead.com

Or this:

ECGAcademy.com
ECGAcademy.com

Further reading:

You said it

Code 3 for seizure. I recognize this address.

A tough-looking, tattooed man in his 30s is on the kitchen floor, not responsive, and not for the first time. His girlfriend tells us, also not for the first time, that he has pseudoseizures and PTSD after being beaten up some time ago.

We go through the usual dog and pony show of an assessment.

I’m totally on autopilot and I don’t even think about word choice before I casually ask, “So, ma’am, what other medical problems does he have besides fake seizures?”

“He doesn’t fake seizures!”

“You just said he has pseudoseizures.”

“Yeah.”

“That is LITERALLY what ‘pseudoseizures’ means.”

You call, we haul. Now get in the friggin' ambulance.

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