Doc Alert: Diagnostic Findings of iPhone Interference onECG

the following is an e-mail i received from my epocrates doc alerts. while interesting, i wonder how the patient managed to bring the charging iphone with him to get the ecg. usually there are cords hanging about when charging a phone. how do you just happen to not see that?

short post today only because i'm about to drop dead. i will have plenty to complain about tomorrow after working 23 hours in 2 days with 3 incompetent techs and a mostly competent intern. (different intern, not talking about myself - i, of course, am completely competent)

Information sourced from BMJ:

Emerg Med J doi:10.1136/emermed-2011-200078
[Link to free full-text Emerg Medicine article PDF] [PubMed® abstract]

Images in emergency medicine

ECG Interference From the iPhone

Accepted 24 March 2011
Published Online First 27 May 2011



Figure 1 ECG acquired before (A) and after (B) removal of charging iPhone.

A 44-year-old man presented to the emergency department with cocaine-induced chest pain. There was no previous cardiac history. His initial ECG was abnormal (figure 1A). On examination, he appeared well and a charging iPhone 4 was found beneath his forearm. The device was removed and another ECG was recorded (figure 1B).

ECG interference can arise from numerous potential sources.AC interference is minimised using physical shielding and electrical filters, essential given that ECG voltages are in the order of millivolts compared with the mains supply (230 V). Direct contact with the device may have bypassed these measures, and figure 1A shows AC interference as the characteristic 'thickened baseline' with 2 sinusoidal waves every 1 small square (50 Hz).

Electromagnetic interference from mobile communication devices is common, hence restrictions on use in certain settings The GSM receiver has been shown to cause high-voltage spike at regular intervals.¹ Figure 1A demonstrates such activity that resembles a pacing spike every 2 small squares caused by abnormal interpretation as genuine pacemaker pulses that are automatically expanded to allow better visualisation. These two forms of interference need to be recognised given how often ECGs are recorded within the emergency department.

Footnotes
Competing interests: None.
Patient consent: Obtained.
Provenance and peer review: Not commissioned; internally peer reviewed.

Reference
1. Baranchuk A, Kang J, Shaw C, et al. Electromagnetic interference of communication devices on ECG machines. Clin Cardiol 2009;32:588–92. [PubMed® abstract]

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Congrats New York!

The news came in a little less than 4 hours ago: New York has made same sex marriage legal! My twitter feed has been blowing up with tweets about this historic night, as has my facebook page...for the most part.
While I rejoice to know that we are slowly but surely progressing to a more equal society, I'm also appalled by the blatant refusal to even acknowledge what has happened by many of my acquaintances. I see this sort of behavior far too often for my comfort. It comes from living in one of the most conservative areas in the nation. What irritates me even more is people that belong to the same religion I do and who use that religion as a basis for their prejudices. My religion, in fact, condemns those who judge others. I was taught to love and accept everyone and to let everyone have their own beliefs, even if I might not agree. I don't want anyone forcing their beliefs on me, who am I to do it to another human being?
Congratulations, again, New York. Let's hope the other 44 states catch up soon.
Sent via BlackBerry by AT&T

the friday five: random

i feel lame for not having much to write about concerning work/pharmacy/stupid people/etc. but it's either been a) so busy at work that the day flies by in a blur after which i come home and pass out only to repeat it the next day or b) so slow i miss the oxycontin addicts who used to fill my days with endless amusement.
i'm assuming everyone else has noticed the downward spiral of oxycontin use. my pharmacist said the other day that it's sad how you can't trust ANYONE to take that medication responsibly - even those patients who i could have sworn were not abusing/selling it have suddenly had it "stop working" for them.
oh! i did get a good laugh the other day. ms. crazypants called to say that her meds had been stolen - but ONLY her controlled meds. she even said "isn't it funny that they didn't take anything else?" yeah. absolutely hilarious. hilarious that you think i would believe you.
is everyone else seeing the price increases for common generic products? like gabapentin, fluticasone, metformin, etc.? what is up with that? the rumor i heard from one of our sales reps was that lisinopril and simvastatin are next to jump up. of course, she could have just been lying to me. like how she lied to me about hyoscyamine so i would buy an entire year's worth only for me to find out the price had dropped a month later. yeah, awesome.
if anyone has news about norgesic forte or midrin, i'd be glad to hear it. we have patients on both meds and idiotic doctors who STILL haven't decided what to prescribe to replace midrin.
enough about the industry talk. it's making me depressed. i've been starting to realize just how much of my brain is dedicated to random pharmacy knowledge that i really couldn't care less about.

the friday five
1. have you ever really lived outside the country of your birth? why or why not?
nope. never had the opportunity to but i would like to live somewhere else and might end up moving out of the country if i go work for a drug manufacturer.
2. what was your first record/cassette tape/cd?
i can't remember my first cassette but the first cd i bought with my own money was celine dion's "let's talk about love." i was 11 years old.
3. what do you think of your parents?
my parents are usually awesome, when they're not being paranoid and overprotective.
4. what is your relationship with your hair?
my hair is the one vanity i allow myself. even though it's pulled back in a ponytail 95% of the time, i wouldn't dream of cutting it. i've recently come to grips with my natural waves which has made me love and appreciate my hair so much more.
5. what kind of pens do you like?
do free pens count? i actually do like drug rep pens. because they're free. otherwise, i prefer the clicky-top pens with a cushy grip. they're the easiest to use when you pick up the phone and a doctor/nurse starts spewing out info for a new prescription before you can manage to say "hello."

pregnant tech

dear pregnant tech,
thank you oh so much for leaving early on friday. i absolutely LOVED staying until 9 p.m. taking care of everything you didn't get done.  you're absolutely right, by the way.  you should go home if you're feeling cranky.  we only want little balls of sunshine working at the pharmacy.  no one else here ever gets cranky and we certainly don't expect you to suck it up.  no, rather you should go home because you're pregnant and special.  i mean, i DID ask you to get knocked up.  and it's not fair to compare you to the pharmacist who is farther along in her pregnancy and who stands on her feet 10 hours every day.  no, if you can't handle 6 hours, you should definitely go home.  oh, and thanks for the text you sent me friday night but there was nothing to apologize for.  you obviously felt like you were in the right to leave so why apologize?  really though, i LOVE spending my friday nights at the pharmacy.
sincerely yours,
the intern
p.s. pharmacist told me you asked her if i would ever forgive you.  what a silly question.  of course i won't.

searches & drug addicts

i was looking over my blogger viewer stats for the first time in months/years and noticed 2 searches that popped up repeatedly:

• "cardinal health" evil
• how to write a percocet script

i love that i'm not the only one who thinks cardinal is evil.  good news, though; my pharmacy switched back to amerisourcebergen.  woohoo!  i love the girls over in customer service.  they're super friendly and actually know what they're doing.  as for "how to write a percocet script" searchers, don't come to my pharmacy.  actually, don't go to any pharmacy where any half-intelligent person works because they *will* see through your lame attempt at forgery.  i mean, you're GOOGLING how to do it, for crying out loud!  on second thought, do come to my pharmacy.  because then we'll call the cops and you'll be arrested.

also, thank you parental unit for thinking i'm a drug addict.  first of all, i work in a pharmacy with very intelligent people who would notice immediately any signs of addiction and they would not hesitate to tell you.  second, i work in a pharmacy and see on a daily basis people who have ruined their lives over drugs.  third, i'm on ONE controlled substance prescription and #120 pills lasted me a year.  not really addict behavior there.  i work in this industry, i know what i'm doing.  have a little faith in the kid that fills your meds, mkay?

medicaid

here are the brilliant formulary changes my state's medicaid program has made:
-the only PPIs they will cover are Aciphex (the last of the Rx ones that's only brand name) and OTC Prilosec
-they will ONLY pay for BRAND NAME Duragesic patches and MS Contin.
and people want to give our government more control over our healthcare? maybe if they weren't being lobbied by drug companies to make all these backdoor deals.

what? percocet's a narcotic?

winner of doctor of the week:

today a lady who we have had a PLETHORA of problems with filling controlled substances at other pharmacies, trying to fill things early, etc., etc. came in today with a percocet prescription. here were the problems:
1. doctor's signature was illegible. he did provide his dea, but fat load of good that did me since we didn't have him in the computer. he didn't bother to print his name any where on the script.
2. the strength was for 5 mg percocet, but the 5 looked like it had originally been something else. what it was, i couldn't tell, i just knew the 5 looked funky.
3. the amount was originally #60 then it was written over to say #80. the doctor did not initial by the change, so i assumed (as an pharmacy would) that the patient had altered it.
4. there were 3 refills written on the script.

just like any other pharmacy would think, we believed the script to have been altered by the patient. the next 20 minutes i spent getting transfered from department to department in the hospital. first to the er, then to her usual doctor who told me that "never, ever, EVER would he write a script for percocet for her." he has obviously had problems with her in the past. when i finally got a hold of the doctor who had written the script, this was how our conversation went:
me: hi! this is the pharmacy calling. we have a question on a script you wrote.
dr: is it for the percocet?
me: uh, yeah.
dr: yeah, i wrote it. i was initially going to write it for 10 mg, then changed my mind halfway through and decided it was too high. so i changed it to 5 mg. but then i had to give her more pills since i lowered the strength, so i changed it from 60 to 80.
me: oh, ok. but this script also has 3 refills on it.
dr: yeah.
me: um, percocet is a narcotic, a C-II, we can't refill it.
dr: oh, well, then just ignore them.

gee, like i wasn't going to do that anyway. thank you SO MUCH for guiding me in the right direction. idiot. the scary thing is, this doctor has had his license for 2 years. i have a hard time believing this is the first time he's written for a narcotic. i wonder how many other pharmacies have had to explain the law to him. he must have slept through that entire part of medical school.

p.s. bad tech left about 4 days after he was hired. i just realized i never wrote about that.