Got a transfer from CSICU yesterday. Pt was post op day 4, slow to progress (we usually get them by day 2), 4 chest tubes, insulin drip, 4L O2 nasal cannula, edema bilaterally in hands and feet. Had CABGx2, MVR, and MAZE procedure, pacing with external pacing wires 80 rate atrial paced with 10 mAs (why with underlying afib, not sure) and junctional rhythm in 30s-40s. Pt still had not been ambulated (again, usually that starts post op day 2) but my esteemed CSICU RN colleague decided RIGHT BEFORE coming up to my floor (a step down) that would be a good time to get her walking for the first time.
So, needless to say, get my new pt all tucked in, the aide checks her blood pressure and her heart rate is 160.
Yes, that's right... 1 6 0
Plug in the telemetry, and she's in rapid afib!
Mother FUCK.
Turn off external pacer, grab a stat EKG, a fresh set of vitals, BP monitoring every 5 minutes..
pt feels nauseous.. THERE'S NO ZOFRAN ORDERED (of course)
Page cardiologist, he orders 5 mg IV lopressor (decreases rate and BP-- rate is what we wanted controlled and her BP was safely high enough to give it) STAT and orders a stat amiodarone (anti arrhythmic). Also orders zofran for pt's nausea. (just read a study on medscape that says zofran increases risk for torsades de pointes, so I had that in the back of my head worrying me too)
Give the IV lopressor.. Pt resting comfortably.. I stay with her watching the monitor to see if her rate comes down. Then she says "I don't feel good..." blinks three times, and nods off..
monitor reads ASYSTOLE (yes that's a fucking flatline, folks.. NO HEARTBEAT)
5 seconds pass.. I call for the code cart..
3 more seconds pass..
still flatline..
2 more seconds pass and
her heart started beating
It was a junctional rhythm but it was beating and it was not afib anymore!! I turned the external pacer back on to the original settings and called the cardiologist to tell him she converted.
How does it feel to stop a patient's heart on purpose?
It feels a lot like you'd imagine.. something like HO-LEE SHIT
(Just to clarify here. There's a procedure called a cardioversion that Drs use to convert people from afib to sinus rhythms. It can be done ONLY in the presence of a cardioliogist and an assisting RN and various equipment nearby because the conversion is sudden and can cause lengthy pauses of the heart (similar to what was seen here). Hearts can also convert into sinus ( with a small pause) while pts are on amiodarone drips (hence why it was ordered). Instances where pts convert from 5 mg of IV lopressor are rare, but it can happen. (Obviously) ..and it has NEVER happened with ME in the room alone.) So, all of this really wasn't a freak occurrence so much as it was just an intense emergent situation I had never been involved in before.)
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