Thursday, October 29, 2009


It's good to have some diagnostic equipment, but not so good when the people using it don't quite understand some of the implications of their findings. Many "technicians" end-up with on the job training and sometimes certain concepts get overlooked. Today, a patient was sent for obstetrical ultrasound because the intern couldn't find a fetal heart beat at 42 weeks. After hearing the story, I decided to wander to ultrasound to see if the baby was still alive. As the tech was measuring fetal bones, I asked if she had already seen a heart rate. Her answer, "Yes." What I should've asked was, "What was the fetal heart rate?" After watching a few minutes and seeing no movement and very little amniotic fluid I asked to see the heart beat. When it was found it was 80 and the tech said, "Slow, just like before." Given that normal is greater than 120 and it seemed the heart rate may have been braycardic for a while I grabbed the patient and said, "She needs a C/S now."

Thankfully the OR had a free room and within 15 minutes (which is nearly a miracle) a 4.0kg boy was born. While he has needed special care in the nursery he is alive and seems to be fairly neurologically intact. Praise God.

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