The ICU doc covering this patient calls me and says, "Can you start a magnesium drip on this guy? His magnesium is really low." So I start the drip, but am running it a little slow, because his pressure is pretty low and I don't want to drop it too bad. I'm sitting back at the desk and I happen to glance over at the monitor and what to my wondering eyes should appear:
I LEAP up, run to the bedside, yelling for a little assistance, check and--no pulse. Then, without even thinking about it, I charge the defibrillator and shock the guy. It was like my hand just flew out there and did it by itself. By the time one of the docs got to me, the guy was back in NSR. The doc said, "Well, looks like you've got this under control. Good job!"
And then I sucked in a big breath because I realized I hadn't been breathing for a little bit there, and then I turned up the magnesium drip a little.
23 comments:
This is what we live for-the moments that make putting up with the drugseekers and the drunks worthwhile!
WOW!!!
Breathing is good.
I like that you turned up the magnesium. The rhythm looks like torsades, so magnesium is most likely to be the effective treatment. Especially with hypomagnesemia.
Too many people would back off on the magnesium, since he coded soon after you started to give it.
Very nice job.
O MY! TORSADES!!! I saw that on the telemetry unit (once, and it wasn't my patient)
That shouldn't excite me, should it?
Rogue:
Thanks! Yes, it was a lovely classic torsades--and the strip I printed out was even better than the picture I grabbed off the Internet. My first thought after my butt unclenched was, "oops, guess I should have ran the magnesium a little faster, BP be damned!"
Little d:
Of course you should be excited! we're in one of the few professions that get really excited about other people's misfortune. It's gruesome, but it's also how we learn about things. You could see Torsades in a book eight zillion times, but once you see it for real? You'll never forget it.
xoxo
GGRN
Would running it faster have prevented the torsades? We can only guess at the answer to that. You chose a rate that seemed appropriate for the patient at the time. How many hypomagnesemic patients have you treated, who did not wander into torsades? Were any of them as sick as this guy was?
If you ran the magnesium in faster, maybe he drops his pressure, and the response is more pressors, then maybe he goes into torsades anyway.
There are many ways to second guess this. There is no one right way to treat every patient. Every treatment you were giving has significant risks. Which is the worst risk? Depends on the outcome. This is well outside the realm of cookbook medicine and clear obvious answers.
A brief pulseless torsades immediately treated with defibrillation and prompt resolution of the arrhythmia. The arrhythmia apparently did not return. I have had plenty of worse outcomes than that. Had he become hypotensive due to running the magnesium in faster, maybe his outcome would not have been so good. This is a good outcome.
Was there no alarm? If you had not "happen[ed] to glance..."?
Anyway, way to think on your feet -- despite the clenched butt! That you did it "w/o even thinking" just proves how very well you process schtuff.
Yeah, sure... I can relate, you know. Just this morning, I did the Heimlich on my choking cat... So I can relate.
Yeah.
Makes all the other crap worth it. You rule.
You're a goddamn superhero. Stuff like this makes me wish I'd had the stones to at least try to get into the medical field.
Uhm, yeah. Don't forget to breathe.
Awesome job, guitargirl.
Use the force.....
way to go girl!! no matter how many times you have to do this it always makes your butt pucker a little.. lol
Good job, and I'm still giggling over the term "butt-clenching moment".
K:
Seriously. I think I still have a piece of underpants stuck I'm there.
I mean IN there. Way to wreck a good joke with a dumb typo.
You earned your pay and then some!
I've had torsades a few times (with Long QT),and it feels just like a hellish rollercoaster, I kid you not. While in it, I knew I had to hang on and ride it out because if I didn't, it wasn't going to go well. Mag works wonders.
Nice save....
Seriously. I think I still have a piece of underpants stuck in there.Interestingly, my rectal sphincter tone relaxes and soilage occurs for me.
Awesome way of phrasing that, Nurse K!
Yes, Grumpy, think complete cord.
Kickass!
Nothing like VFib to give you AFib yourself :)
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