Insulin for All

What are the odds regarding a medical mistake?
To happen twice in two months; news that isn't fake,
Regarding Insulin injection not on hospital grounds
The community at large is not out of bounds.

Insulin is dangerous, if it isn't needed
Blood sugar dropping completely unheeded,
Brain cells die fast, but it's just teenagers, right?
Maybe no one will notice at the end of the night.

Who packed the supplies before they were used?
The vials look different, how could they be confused?
Who was giving those shots, was it a regular assignment?
Or some dubious cause; the stars were not in alignment.

In the hospital we are advised
Perform two-person verification,
On many dangerous drugs
For self preservation,
Because if you screw up
And somebody dies,
You won’t be saved by your
Tears and your lies.

I’m pretty sure all nurses have medication errors
And some drugs can give you the willies and terrors,
Imagining the outcome with Nipride or Isuprel?
Take it from me, things don’t go so well.

Even a simple vaccination or TB skin test
Deserves the highest of caution, to perform at your best,
For the safety of the customer, as well as your career
Also, turn off your cell-phone, when the public is near.

Sept. 30, 2019: https://www.wishtv.com/news/local-news/students-hospitalized-after-receiving-insulin-during-tb-skin-test/

November 7, 2019:
https://www.kjrh.com/news/local-news/insulin-shots-given-by-mistake-instead-of-flu-shots

QRS Measuring

Basic EKG / ECG monitoring skills and certification, are now standard requirements in many hospitals and clinics. It certainly helps to have some prior exposure to the concepts, but in our class, it is not demanded as a prerequisite.

One of the most difficult skills to acquire, is the accurate measuring of the width of the QRS complex. We haven't been talking about the J-Point all this time, but now I have proposed that it become a part of our curriculum; this is currently under review.

Measuring Q

QRS measuring
It is tough to get it right,
Without proper instruction
Or low light at night,
One needs to understand the process
Of electrical action,
Dynamic to passive
To complete the transaction.

Does the monitor display
Just one line or six?
Are the QRS segments
Where they belong in the mix?
Because sometimes a Q-wave
Doesn’t show in the picture,
Or the R-wave went south
Like an esophageal stricture.

And what about that S-wave?
New students pass it over,
Measuring to the far side of the R
Like a hostile takeover,
Staking a claim
That the QRS is point-oh-four,
On an adult with heart disease
You need to double that score.

An important understanding
Regarding ionic flow,
Depolarizing is fast
And Repo is slow,
Thus, the QRS vectors
Show as quick straight lines,
Whereas repolarization
Has sloppier designs.

Is the ST-segment elevated
Or below the Iso-line?
Both will skew the measuring
So you must carefully assign,
The ending of the QRS
The crux of the problem at hand,
It is time to meet the J-Point
To fully understand.

The J-Point is found
At the S-wave end,
There is a shifting in direction
Like at a corner, then a bend,
It may be subtle or bold
The transition in the flux,
Study carefully the waves
Before you shoot your ducks.