Stage of Illusion
Report:
Sinus rhythm 63/min
Normal trace
Comment:
This is a potentially dangerous situation: acute infarct pattern normalises in that ST segments are again isoelectric and the T wave have not yet turned. Below (Fig 54a) is the trace taken 3 hours previously; next (Fig 54b) is the one taken a day later.
The patient should never be sent home because of a normal ECG. The act of taking an ECG implies suspicion of infarction or ischæmia â neither can be excluded so easily. A reasonable course of action is either to sent the patient out without an ECG (because an alternative diagnosis is established) or get a (properly insured) Cardiologist to do the sending home with normal ECG. A trained mind is legally allowed to err.
54a. Admission ECG in Casualty. Acute inferior MI. 54b. Day later. Evolving inferior MI.
55. Ventilated 45 year old man with septic shock from Capnocytophaga canimorsus.
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