Friday, April 9, 2010

POS Cardiology Consult

Cardiology consults can be such a waste of time it's a wonder we bother getting them at all.  Around here it has almost become a joke.  I was seeing my next patient for a PEG placement, an elective procedure.  She was an inpatient with a positive review of systems:  obesity, hypertension, diabetes, CVA, CHF, renal failure on hemodialysis, A-fib...  We hooked her up to the monitors in preop and lo and behold, her vitals signs were: HR 120-140 in A-fib, BP 170/110.  Occasionally her heart rate surged to 150 when she coughed.  Not a pretty picture for an elective case.

I flipped through her voluminous chart to see why how long she had been in this condition.  Vital signs from two days before showed normal heart rate and normotension.  Cardiology was consulted yesterday when she was found to have converted into rapid A-fib.  They gave her some metoprolol and said she was cleared for the procedure.  Their advice was to continue beta blockers and maintain her blood pressure.  From their point of view the patient needed the PEG so she could get her medications.  Hello?  Have they never heard of IV meds?  Were they even trying to rule her out for an MI?  I thanked them for allowing me to bill for an anesthesia consultation and sent her back to her room.  Call me when she is "medically optimized".

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