Mistaking Your Pulse For the Patient's

[VentMedic]

I saw this posted on another forum and thought it would be a good read here since we have a lot of people new to the field.

It is a very well written article by the person this actually happened to.

For educational purposes, proper assessment and good technique should be well learned and followed.

This thread is not initiated with the intent to be critical of the person this happened to. She gives a very honest account of her mistake.


The Man in the Blue Pajamas
By JEN UMLAS
Published: May 4, 2008

http://www.nytimes.com/2008/05/04/nyregion/thecity/04save.html

MY parents were volunteer emergency medical technicians for two decades, so I expected I would be great at the job. I certainly had parental support. When I mentioned to my mom in 1996 that I was thinking of becoming an E.M.T., she all but picked me up and carried me into the training hall, right down the block from our house on Eaton Court in Gerritsen Beach, Brooklyn.

That’s what happened one day in the late 1990s with John, a 75-year-old who was lying on the couch of his home in his pajamas, light blue as I remember, when we arrived. He reminded me of the men in my Grandpa Tom’s bridge club, all gray hair and thick glasses and hearty laughs. He had been having chest pains, and as it turned out, he had undergone bypass surgery less than a week before.

Then, however, as I looked at his face through the oxygen mask, it seemed as if John wasn’t breathing regularly. I asked our driver to take a look. When a person’s breathing becomes inadequate, his pulse soon weakens, but because John’s pulse was strong, I was not sure what was going on. Because I’d been an E.M.T. for only two years and went on a few calls a week instead of a few a day, I hadn’t built up much experience. The driver, who was about my age, was even greener than I was and had somewhat less medical training. The officer had 15 years on us, but she was dealing with the family.

http://www.nytimes.com/2008/05/04/nyregion/thecity/04save.html

The two city E.M.T.’s had John moved to the floor in case we needed to perform CPR, and then attached their defibrillator to his chest. I moved my hands away because I knew that anyone touching a patient would have his or her pulse appear on the monitor, too. But the partner waved me back toward the patient. I put my hand back on John’s wrist and, when I looked at the monitor, I immediately knew why I had been motioned back.

There was only one pulse. Mine. John’s heart had stopped sometime in the last few minutes and I had done nothing because I’d thought that my heartbeat was his.

http://www.nytimes.com/2008/05/04/nyregion/thecity/04save.html

 

[Kimmy Schaub]

Just remember, never take a pulse with your thumb, as this will definately happen to you!!

 

[Ridryder911]

Couple of things that could be misinterpreted and truthfully is wrong. ..."I moved my hands away because I knew that anyone touching a patient would have his or her pulse appear on the monitor:... Not really. One may exhibit artifact, and even possible that is a big assumption, one may pick the providers electrical activity. Also, ECG does not provide if there is a pulse or not, only electrical activity.


..."I put my hand back on John’s wrist and, when I looked at the monitor, I immediately knew why I had been motioned back."...... One should not be checking pulses on the wrist or radial in critically injured patients. Rather carotid, femoral or an apical pulse.

It does make good very valid points, to remember to assess your patients thoroughly and remember the House of God rule..

R/r 911

 

[Tincanfireman]

It does make good very valid points, to remember to assess your patients thoroughly and remember the House of God rule..

For the enlightenment of our newer members who have never read (or heard of) Dr. Shem's literary/medical masterpiece, look here. Regarding which rule of the hallowed 13 that Rid is referring to, you're on your own...

 

[traumateam1]

I've never gotten my own pulse when assessing a patient. Isn't the only way to accomplish that by taking your patient's pulse with you THUMB.
Once again, I'm always open to ideas and corrections if I'm wrong.

 

[mikeylikesit]

you can pick up your own pulse sometimes if you push hard enough. like when you smash your hand and it "throbs". this sounds like she was not treating the patient but rather the symptom. at least she was honest about her mistake.

 

[Ops Paramedic]

It takes a man on a horse, and not a mouse on tu.. to stand up and say: I made a mistak, so good on her.

She thinks had mistakenly percieved her own pulse's pulsations for those of the patient. Who knows if she did or not?? If she did, she would only fall into a very large catagory of even highly educated and skilled practitoners who also mistake their own pulse's pulsation for the patients.

The ECG, hmmm, I agree with rid, and would add that the (trans thoracic) impedance would be far to great for her touching the rist to produce any form tracing on the screen, however it should be standard practice to avoid touching the patient when recording or analising the rythm in order to reduce the artifact.

There are a few ways that one can confirm a if the patient has cardiac output (Palpable pulse). Use these methods inconjunction with each other to confirm any suspicions, as well as do not be affraid to ask some else to confirm your findinds.