Question

Eliot Masterson, a 41-year-old business owner, was seen by Dr. Salpega for a routine physical. During the office visit, Eliot informed Dr. Salpega that he has had some episodes of chest pain over the past few months that have occurred after exercising. Dr. Salpega decides to have his medical assistant, David Dolan, perform an ECG on Mr. Masterson.

1. When the medical assistant asks Mr. Masterson to lie down on the examination table for the ECG, the patient informs the MA that he has a back problem and is unable to lie down on his back. If you are the medical assistant, how would you handle this situation? What would you specifically tell the patient and ask him to do?

2. When the ECG tracing begins, the medical assistant notices that the baseline is wandering on the paper. What is probably causing this? What should the medical assistant do to correct the problem?

3. When the ECG is complete, the patient asks the medical assistant if it looks alright. What should the medical assistant tell the patient? Be specific about what the patient should be told.

Answer 1

1. When the medical assistant asks Mr. Masterson to lie down on the examination table for the ECG, the patient informs the MA that he has a back problem and is unable to lie down on his back. If you are the medical assistant, how would you handle this situation? What would you specifically tell the patient and ask him to do?

Some patients are hesitant to cooperate during diagnostic procedures like ECG, this might be due to multiple reasons. In this situation as a medical assistant, it is out job to first make the patient feel comfortable in the environment and ask if he can try to sleep in supine and try at least. Explain the patient the importance of being in the supine position when taking ECG. Tell Mr. Masterson that if the ECG reading is not taken into sleeping or supine position, it can lead to errors in reading which can generate false results and the reason behind his chest pain will not be correctly diagnosed. There can be changes in the P waves generation by left lateral pressure right lateral position and ECG can be of no use for correct diagnosis. After explaining these outcomes, it can help the patient Mr. Masterson to sleep in supine position for the ECG. If even then patient is unable to lie supine then the ECG can be taken in semi fowlers position and accommodate the patient's physical restrictions in such situation.

2. When the ECG tracing begins, the medical assistant notices that the baseline is wandering on the paper. What is probably causing this? What should the medical assistant do to correct the problem?

The baseline wandering during the ECG can be due to multiple reasons or causes such as

1. Loose connection of the electrodes attached to the patient Mr. Masterson's body,

2. Loose contact or improper connection between the equipment electrodes and wires

3 Body surface of Mr. Masterson can be wet which can lead to baseline wandering

4. Mr. Masterson unusually breathing hard during the ECG can also lead to baseline wandering

To correct this problem the assistant can re-check the connection of the equipment if the are attachment correctly. The electrodes attachment to the body of the patient can be reattached and checked for correct alignment. Also patient Mr. Masterson has to be told to be calm and breathe naturally and in normal manner and start ECG only when the patient is comfortable to undergo the ECG procedure.

3. When the ECG is complete, the patient asks the medical assistant if it looks alright. What should the medical assistant tell the patient? Be specific about what the patient should be told.

I is a common sight that patient asks MA about the results and interpretation after the ECG. So in this case the the MA should inform the patient that the results will be carefully studied by the physician or nurse practitioner after presenting this ECG. Till then ask the patient not to worry but seek consultation and the treatment shall be given as per the required condition but until then not to worry or be stressed about it.