Two caveats.
1. I love The Pitt. It is the best show on TV and one of the best ever. It gets the emotion of emergency medicine right, and for the most part gets the medicine right, which is no small task.
2. I hate nitpickers, who point out little minor details, not recognizing that the show is TV and sometimes you have to adjust to make the drama to keep people from falling sleep.
That said, I have consistently said that The Pitt does not do a very good job when it comes to EMS in how it displays paramedics and EMTs and the interaction in the ED. In this show it seems every time EMS brings in a patient, they are either met at the ambulance doors or the ED doors by an ED doctor who wants the story. In over 30 years as a field paramedic, I don’t think a doctor has met me outside the ED more than once or twice and I can’t remember those once or twice occasions so maybe they never happened. Sometimes an ED physician will ask me in the hallway what I have, but that is usually while I am waiting for a room. The bulk of Paramedic MD interaction on critical calls comes when the patient is transferred over to the bed and you give your report. You call in a trauma alert. The doctor is waiting for you not in the ambulance bay, but in the trauma room. On noncritical patients, the report is usually just given to a nurse and you never see the MD. Most of the time the doctors are in their glass walled box charting, The Pitt does get that right as far as Santos charting, but you never see any of the other doctors charting and charting is a huge time killer. Of course, showing the doctors charting is not very good TV.
Anyway on to episode 14, and a nit pick, but one with key consequences if I am right.
Dr. Robby is having a meltdown, yelling at everyone. He unloads on two paramedics for failure to put electrodes in the proper place to do an ECG. Their patient had large breasts and he alleges they were too afraid to lift the woman’s breasts up and place their electrodes under her breasts in a spot closer to ideal. Instead, they have them too low in his opinion and this causes the 12-lead to read normal instead of indicating a heart attack. There is some validity to this plot line. It is true if electrodes are improperly placed, they can hide a STEMI. Some medics are reluctant to place electrodes under a woman’s breasts, but most do one of three things. 1. Have your female partner do it. This crew had two men so that was out. 2) Use the back of your hand to lift the breast, or 3) what I do is ask the patient to cup her breast with her right hand and lift it up so I can properly place the electrode under her left breast.
One small point to start. I would have chosen an inferior STEMI instead of a lateral STEMI and had the incorrect placement done with the right leg limb lead being placed far on the torso right flank, rather than on the right leg where the limb lead is supposed to go. This is far more common error. But of course it doesn’t play into the you are too afraid to move the woman’s breasts theme.
Now the final and main point. The electrodes that are on the woman are tab electrodes, typically used in the ED, not the snap-on electrodes usually used by EMS. The Pittsburgh crews on The Pitt have what appear to be Stryker LIFE Pack heart monitors and Life Packs use the snap-on cables/electrode, not the clip-ones cables with the tab electrodes. In other words, if I am correct, the misplaced electrodes were misplaced by the ED staff when they must have done a 12-lead, not by EMS who does not use that brand of electrode.
(In truth, I think this is just a mistake by whoever was in charge of that scene. Likely not a paramedic who would know to use the snap-on electrodes.)
So the medics should have told Dr. Robby to F-off, and told him to teach his own staff how to put the electrodes in the right place, and also tell his staff to own up to their own mistakes and not to blame the innocent hard working medics, but of course, the medics were far too professional to do so.
If the medics did do a proper 12-lead with their LifePack and its snap-on cables, you ask, why didn’t it show a STEMI. The medics, I will say, did serial 12-leads, but none showed ST elevation because the elevation simply hadn’t popped yet. That’s why you do serial 12-leads and why the ED would have done their own as soon as they took over care. They did their own, but put their tab electrodes in a poor position.
-This post has been brought to you by the anti-paramedic defamation society.–
Note: I have never seen any paramedic use tab electrodes and have clip-on cables. I have always used Life Packs and never seen them have clip-on cables. I looked at their manuals and all the manuals just picture snap on cables. Is it possible paramedics use the tab electrodes? Maybe somewhere, but not likely if they are using Life Packs.