Dr. Kenneth Orimma, former Emergency Room doctor at the QEH. Dr. Orimma presented a paper on?????Missed Myocardial Infarctions or Serious Arrhythmias Among Patients Discharged with Chest Pains in the Emergency Department: A Need for ECG Audit???, at the 24th Annual Cardiac Conference that was held at the Hilton Barbados from July 28-31.

There is a need for doctors to obtain more training in the interpretation of electrocardiograms (ECG).

This is the view of Dr. Kenneth Orimma, one of the presenters at this year’s 24th Annual Caribbean Cardiology Conference, and a former emergency room doctor at the Queen Elizabeth Hospital (QEH).

Dr. Orimma delivered a paper on the topic: "Missed Myocardial Infarctions or Serious Arrhythmias among Patients Discharged with Chest Pains in the Emergency Department:?? A Need for ECG Audit".

In making the call for training to upgrade physicians’ skills and knowledge in ECG, he said: "Emergency physicians should be trained and obtain refresher courses, because a lot of these diagnostic tools are evolving everyday with new modalities and changes. So, we should actually be keeping abreast of recent developments in ECG interpretations."

According to him, the training should not only target emergency room physicians, but also other specialists at the QEH. "Any patient can develop or have a myocardial infarction. It could be in the labour ward, general ward or renal unit; hence, every physician should be able to interpret ECG, not just the emergency room doctor," he explained.

While pointing out that the costs for training was hardly prohibitive, he urged that it be considered by polyclinics and other health facilities. "This broad-based approach across the health sector would go a long way in meeting international health standards of the management of heart conditions," said Dr. Orimma.

It was also pointed out that the emergency physician was the gate-keeper in deciding which chest pain patients are discharged or admitted to the hospital and that the main tools available for such crucial decisions were the ECG and the cardiac markers. "The emergency room ECGs, need to be interpreted correctly to avoid inappropriate diagnosis and disposal of patients with grave consequences," he stressed.

Dr. Orimma’s paper recommended that there be formal training of physicians by a cardiologist, and the introduction of an ECG Report Quality Assurance Programme in the emergency department to ensure proper treatment, risk stratification, disposal and follow up care of patients with acute chest pain syndrome.

The 2007 study conducted by Dr. Orimma, under the tutelage of Cardiologist, Dr. Raymond Massay, evaluated the accuracy with which emergency physicians interpreted ECGs by comparing their report with that of the cardiologist, using a double-blind prospective ECG/Chart Audit.

Dr. Massay, the Vice President of the Caribbean Cardiac Society and the conference chairman, was credited by Dr. Orimma for introducing, for the first time, a basic ECG course to the conference agenda.??

The course, which was deemed successful by participants, was conducted on July 29. It was geared towards increasing the knowledge and interpretation skills of medical students, general practitioners, hospital residents, nurses and paramedical professionals.


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