Anterior Ischemia or Syncope?

jrm818 said:
This is over the top. Goodcross, I think you need some direct (I'l try to keep it non-snarky) guidance.

You are very very new to medicine. Your medical knowledge is extremely small. Everyone here was once new, and everyone here once had a very small level of knowledge. That's OK.

Just know that the mountain of medical knowledge you don't have is so high that you can not see the peak. "you don't know what you don't know" is a commonly repeated phrase in medicine and you should take it to heart - there is great danger in overestimating your knowledge or abilities.

That said, your role is to basically keep quiet and keep learning. It is inappropriate for you to make judgement about a physician's medical decision making. I assure you, you do not have the knowledge, perspective, or experience to critique a cardiologist's evaluation of syncope. There are doubtless bad physicians, but you are not in a position to decide who they are yet.

The cardiologist in question has seen thousands of patients and been individually responsible for making long term life altering decisions for them. (Many of them probably about syncope!) As near as I can tell, you have not yet been responsible for making even the most trivial of decisions for a single patient during a short transport. Do not underestimate the lack of perspective you have.

There is a temptation as a new EMT to try to become "part of the club" by parroting things you've heard, criticizing others, and basically coming off as a jaded, experienced provider. Many here, including myself, have probably fallen in to it. So have you.

The problem is it doesn't work - for example, it is very clear from your posts on this thread that you don't have the slightest idea what you are talking about when it comes to: evaluating syncope, cardiology, arrythmias, how ECG's work, the way your state EMS system works, medical liability, medical decision making, or the idea of defensive medicine. You aren't coming off as anything but arrogant and frankly a little crazy.

You need to refocus on learning. Listen more, talk less. Stay humble.

A good approach is to take this call and try to learn as much as possible about it.

Go read about syncope. Try to figure out what the cardiologist was thinking. Learn to make a differential diagnosis for syncope. What are the possible causes? How can you rule every indiviudal cause in or out? Which causes are dangerous today, this week, or this year? What is the immediate treatment (at your level and beyond) for each of the causes?

What is "vasovagal" syncope? what is the vagus? What are the parasympathetic and sympathetic systems? etc. etc.

Come back with questions not opinions.

Once you have done that, rinse and repeat. Don't think you are done. Keep in mind that the physician you are so happy criticizing can do this effortlessly without looking anything up. This is barely scratching the surface of his/her level of knowledge.

Good luck.
Click to expand...
Best post in this thread, hands down.
 
No comment on that reply.
 
jrm818 said:
This is over the top. Goodcross, I think you need some direct (I'l try to keep it non-snarky) guidance.

You are very very new to medicine. Your medical knowledge is extremely small. Everyone here was once new, and everyone here once had a very small level of knowledge. That's OK.

Just know that the mountain of medical knowledge you don't have is so high that you can not see the peak. "you don't know what you don't know" is a commonly repeated phrase in medicine and you should take it to heart - there is great danger in overestimating your knowledge or abilities.

That said, your role is to basically keep quiet and keep learning. It is inappropriate for you to make judgement about a physician's medical decision making. I assure you, you do not have the knowledge, perspective, or experience to critique a cardiologist's evaluation of syncope. There are doubtless bad physicians, but you are not in a position to decide who they are yet.

The cardiologist in question has seen thousands of patients and been individually responsible for making long term life altering decisions for them. (Many of them probably about syncope!) As near as I can tell, you have not yet been responsible for making even the most trivial of decisions for a single patient during a short transport. Do not underestimate the lack of perspective you have.

There is a temptation as a new EMT to try to become "part of the club" by parroting things you've heard, criticizing others, and basically coming off as a jaded, experienced provider. Many here, including myself, have probably fallen in to it. So have you.

The problem is it doesn't work - for example, it is very clear from your posts on this thread that you don't have the slightest idea what you are talking about when it comes to: evaluating syncope, cardiology, arrythmias, how ECG's work, the way your state EMS system works, medical liability, medical decision making, or the idea of defensive medicine. You aren't coming off as anything but arrogant and frankly a little crazy.

You need to refocus on learning. Listen more, talk less. Stay humble.

A good approach is to take this call and try to learn as much as possible about it.

Go read about syncope. Try to figure out what the cardiologist was thinking. Learn to make a differential diagnosis for syncope. What are the possible causes? How can you rule every indiviudal cause in or out? Which causes are dangerous today, this week, or this year? What is the immediate treatment (at your level and beyond) for each of the causes?

What is "vasovagal" syncope? what is the vagus? What are the parasympathetic and sympathetic systems? etc. etc.

Come back with questions not opinions.

Once you have done that, rinse and repeat. Don't think you are done. Keep in mind that the physician you are so happy criticizing can do this effortlessly without looking anything up. This is barely scratching the surface of his/her level of knowledge.

Good luck.
Click to expand...

/thread
 
GoldCross: Just for the record - We aren't trying to gang up on you or make you feel bad... We are trying to help you keep your foot out of your mouth, especially at work.
 
jrm818 said:
This is over the top. Goodcross, I think you need some direct (I'l try to keep it non-snarky) guidance.

You are very very new to medicine. Your medical knowledge is extremely small. Everyone here was once new, and everyone here once had a very small level of knowledge. That's OK.

Just know that the mountain of medical knowledge you don't have is so high that you can not see the peak. "you don't know what you don't know" is a commonly repeated phrase in medicine and you should take it to heart - there is great danger in overestimating your knowledge or abilities.

That said, your role is to basically keep quiet and keep learning. It is inappropriate for you to make judgement about a physician's medical decision making. I assure you, you do not have the knowledge, perspective, or experience to critique a cardiologist's evaluation of syncope. There are doubtless bad physicians, but you are not in a position to decide who they are yet.

The cardiologist in question has seen thousands of patients and been individually responsible for making long term life altering decisions for them. (Many of them probably about syncope!) As near as I can tell, you have not yet been responsible for making even the most trivial of decisions for a single patient during a short transport. Do not underestimate the lack of perspective you have.

There is a temptation as a new EMT to try to become "part of the club" by parroting things you've heard, criticizing others, and basically coming off as a jaded, experienced provider. Many here, including myself, have probably fallen in to it. So have you.

The problem is it doesn't work - for example, it is very clear from your posts on this thread that you don't have the slightest idea what you are talking about when it comes to: evaluating syncope, cardiology, arrythmias, how ECG's work, the way your state EMS system works, medical liability, medical decision making, or the idea of defensive medicine. You aren't coming off as anything but arrogant and frankly a little crazy.

You need to refocus on learning. Listen more, talk less. Stay humble.

A good approach is to take this call and try to learn as much as possible about it.

Go read about syncope. Try to figure out what the cardiologist was thinking. Learn to make a differential diagnosis for syncope. What are the possible causes? How can you rule every indiviudal cause in or out? Which causes are dangerous today, this week, or this year? What is the immediate treatment (at your level and beyond) for each of the causes?

What is "vasovagal" syncope? what is the vagus? What are the parasympathetic and sympathetic systems? etc. etc.

Come back with questions not opinions.

Once you have done that, rinse and repeat. Don't think you are done. Keep in mind that the physician you are so happy criticizing can do this effortlessly without looking anything up. This is barely scratching the surface of his/her level of knowledge.

Good luck.
Click to expand...


Great advice, and as a somewhat new provider it's something that I need to be reminded of occasionally myself. Thank you for taking the time to write that out.
 
I was just so confused by this entire thread until jrm piped up.
 
I did not get scared away, I am just learning folks. I am just a probie. I never said that I the cardiologist was wrong. I just think he jumped the gun. I know about syncope and patients passing out. I apologize I discussed the wrong information. All I did on the scene is give the patient O2 and asked the patients medical HX and I saw the strip of the 12 lead and I saw anterior ischemia. Thats all. And all I wanted to know if this patient was having a MI or V-FIB being that the doctor said that he felt no pulse a few seconds after the patient passed out. I am just a EMT-B not a paramedic, I know I have go within:angry: my scope of practice. I am supposed to do what he or she orders me to do. I hope I have kind of cleared up this mess in this discussion.<_<
 
Last edited by a moderator:
Good for you for taking constructive criticism. We were all there.
 
Goldcross is buying! ;)

Good on ya!
 
GoldcrossEMTbasic said:
...and I saw the strip of the 12 lead and I saw anterior ischemia...
Click to expand...

If you take one minor thing away from this it is to throw away that term. Forget you ever saw it or heard it! :-)

(Either there was diffuse subendocardial ischemia or there was a reciprocal change. Ischemia cannot be localized on the surface ECG.)

GoldcrossEMTbasic said:
May I ask what I am buying?
Click to expand...

I'll buy your next round if you promise when you go to paramedic school to correct anybody who tells you otherwise!
 
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