Elderly patient comes to ER for "feeling my heart pounding."
Patient seen my emergency room doctor, who does "physical" from EKG and recommends admission (it was thought to caused by his heart, after all).
Nurse notes slow heart rate. Recognizes intermittent complete heart block on telemetry. Asks electrophysiologist if he has been consulted.
Electrophysiologist has not been consulted. It is Friday.
Electrophysiologist notes patient is to receive the blood-thinner Lovenox and was presribed warfarin (Coumadin). Reviews EKG - Intermittent complete heart block and Mobitz II AV block on EKG from evening prior.
Electrophysiologist wonders "Why would anticoagulation be prescribed for person who might need pacemaker?"
So he signs on the Emergency Medical Record (EMR) system to write order to stop lovenox therapy until decision is made regarding pacemaker implant.
At which time he the orders algorithm of the EMR suggests that "patient's age and risk factors warrant use of DVT prophylaxis."
Electrophysiologist is enlightened.