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  • An investigation is only as good as its 'weakest limitation'
  • A device is only as good as the thing between the interpreter's ears
  • What the mind does not know - the eyes will not see
  • If an investigation and clinical sense does not correlate - another investigation should be done to disprove the previous assumption/investigation

Investigations are as useful as the person interpreting it. Very often common clinical skill and judgment is replaced by slavish following of protocols and numbers and values without taking the total clinical picture of the patient. We treat the patient and not the investigation.

VOMIT (Victim of Medical (or modern) Imaging (or investigational) Technology) is an acronym for our times. First coined by Richard Hayward in 2003 in the BMJ, VOMIT is a term for the patients who suffer unnecessary interventions for abnormalities observed by imaging or other investigational technology, but not found during surgery.(Richard Hayward. VOMIT (victims of modern imaging technology)—an acronym for our time BMJ 2003;326:1273 (7 June), doi:10.1136/bmj.326.7401.1273)[1]


Related to VOMIT is BARF: BARF - Brainless Application of Radiological Findings. BARF is another way of saying that the x-ray/ct/mri/ultrasound is treated, not the patient. An example is included in the ensuing link. [[2]]

A very common error is to have a cardiac output catheter (Pulmonary / PICCO)and either disregard the numbers when low or over-interpret when the readings are not accurate. Both can be detrimental. The important thing is to prove that a particular investigation is wrong by using some other modality and to then disregard the results. Not doing so can lead to under treatment or unnecessary over treatment.

Other common VOMIT errors

Damped arterial trace

Hyperdamped arterial trace

ECG leads slipping off and no recognizing an actual arrhythmia.

Relying too much on the pulse oximeter value

CCO values while cold fluid is running in the line

PICCO values with a damped catheter.

Treating Hyperkalemia due to hemolysed sample.

The reverse - disregarding a high K value.

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