The CPR thread reminded me of a couple of experiences I've had in real CPRs. Both are CoC stories, but both are kind of funny in retrospect.
OK, here's the thing you need to understand about defibrillators. A lot of people refer to them as being used to "restart the heart."
Bupkis. Defibrillators do not restart your heart. They generate electricity for the sole purpose of INTERRUPTING a deadly heart rhythm, specifically V Tach or V Fib. They stop the heart; the hope is the heart will restart itself in a healthy rhythm.
/background.
Not yet, Sapphire!
Another thing defibrillators do is synchronized cardioversion. We use a lower setting (joules) to interrupt an unhealthy rhythm that is not immediately life threatening (A fib or PSVT usually). Because it is painful to shock someone, informed consent and sedation are required. The defibrillator does not deliver the shock until it is synchronized with the patient's heart beat, to avoid sending the patient into a deadly rhythm.
SO we sedate a guy in rapid a fib after getting informed consent. The doc tells me what to set the machine to, I do so and place the paddles on the patient chest. She's explaining to the patient what is going to happen next, and says, "and then the nurse will shock you." I heard, "shock him" and fired the machine.
The doc was holding the metal side rails while talking to the patient. She let go quickly exclaiming, "Not yet, Sapphire!"
oops.
Me: Oh, I'm so sorry, Doctor.
You see, the problem is when you shock someone, electricity follows the path of least resistance. It goes into the patient, and then into anything attached TO the patient. Like the bed.
That's why you hear the actors on those medical shows yell "Clear!" before shocking the patient . . . to warn their co workers.
The good news is, the patient converted to sinus rhythm and didn't need another shock.
There's a reason they're called electrolytes . . .
Fast forward a couple of years. Different ER, different state. Much smaller ER, we didn't see a lot of codes. There's me, another nurse (kinda old and broken down, she should have retired but couldn't afford to) and the doc. We get a CPR in progress.
Medics bring the patient in, and we start the code. I'm doing most of the CPR because the other nurse physically can't do it, but I'm not a CPR machine. It's very tiring. So the doc actually takes over at one point. Meanwhile, he orders some Epi, which I then give. No sooner do I give the epi, I feel this painful shock in my hands and drop the ampule (which is glass and shatters on the floor).
The other nurse had panicked and followed up with a defib at 360 joules (without an order) and without calling out clear. The shock when right up the IV line into my hands as I push medication through the metal needle into the sodium electrolyte solution.
My language was . . . colorful.
I probably deserved it though, in retrospect
OK, here's the thing you need to understand about defibrillators. A lot of people refer to them as being used to "restart the heart."
Bupkis. Defibrillators do not restart your heart. They generate electricity for the sole purpose of INTERRUPTING a deadly heart rhythm, specifically V Tach or V Fib. They stop the heart; the hope is the heart will restart itself in a healthy rhythm.
/background.
Not yet, Sapphire!
Another thing defibrillators do is synchronized cardioversion. We use a lower setting (joules) to interrupt an unhealthy rhythm that is not immediately life threatening (A fib or PSVT usually). Because it is painful to shock someone, informed consent and sedation are required. The defibrillator does not deliver the shock until it is synchronized with the patient's heart beat, to avoid sending the patient into a deadly rhythm.
SO we sedate a guy in rapid a fib after getting informed consent. The doc tells me what to set the machine to, I do so and place the paddles on the patient chest. She's explaining to the patient what is going to happen next, and says, "and then the nurse will shock you." I heard, "shock him" and fired the machine.
The doc was holding the metal side rails while talking to the patient. She let go quickly exclaiming, "Not yet, Sapphire!"
oops.
Me: Oh, I'm so sorry, Doctor.
You see, the problem is when you shock someone, electricity follows the path of least resistance. It goes into the patient, and then into anything attached TO the patient. Like the bed.
That's why you hear the actors on those medical shows yell "Clear!" before shocking the patient . . . to warn their co workers.
The good news is, the patient converted to sinus rhythm and didn't need another shock.
There's a reason they're called electrolytes . . .
Fast forward a couple of years. Different ER, different state. Much smaller ER, we didn't see a lot of codes. There's me, another nurse (kinda old and broken down, she should have retired but couldn't afford to) and the doc. We get a CPR in progress.
Medics bring the patient in, and we start the code. I'm doing most of the CPR because the other nurse physically can't do it, but I'm not a CPR machine. It's very tiring. So the doc actually takes over at one point. Meanwhile, he orders some Epi, which I then give. No sooner do I give the epi, I feel this painful shock in my hands and drop the ampule (which is glass and shatters on the floor).
The other nurse had panicked and followed up with a defib at 360 joules (without an order) and without calling out clear. The shock when right up the IV line into my hands as I push medication through the metal needle into the sodium electrolyte solution.
My language was . . . colorful.
I probably deserved it though, in retrospect
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