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Well, that was shocking!

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  • Well, that was shocking!

    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
    They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

  • #2
    Quoth Sapphire Silk View Post
    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.
    Hey, asystole is still a rhythm. Just not one shocking is going to do any good for.

    I haven't been in any codes (yet, knock on wood), but I do have some "fun" stories since I do stress tests. When budget cuts hit, we lost our EKG techs in the stress lab. Meaning we would have to be hooking up patients to 12-lead EKGs. Now I knew where the stickers and wires went, but as far as what the squiggly lines meant I only had a vague idea. After a couple near catastrophes, a few direct admits and sending several patients to the cath lab, our bosses finally decided, hey, we might need to know what those squiggly lines mean.

    So me and the PRN tech were covering while the two girls who normally work cardiology went to the class. Our last patient did fine with her stress test and as we were getting ready to unhook her she mentioned not feeling well. We turned to look at the monitor and she had shot into SVT (supraventricular tachycardia -- basically the atria (top chambers of the heart) go haywire and start pumping really fast). The nurse practitioner supervising was yelling for the amioderone (at least I think it was amioderone) to try to slow the patient's heart rate down and we didn't have the right saline concentration in the department. So we had to crack open the crash cart. Crash cart didn't have the right bag either, so someone had to run (literally) to the cath lab to get what we needed. Now we stock the right bags.

    I took the class a few weeks later. Just a few days ago we got a patient who had second degree AV block (where there's a delay between your atria and ventricles talking to each other), which I hadn't seen in real life before. If you ever get a chance to take a basic EKG class, do it. It's really fascinating.
    I am no longer of capable of the emotion you humans call “compassion”. Though I can feign it in exchange for an hourly wage. (Gravekeeper)

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    • #3
      Technically, asystole is NOT a rhythm. It is the lack of a rhythm.

      Yeah, it is pointless to have a tech hook someone up to a 12 lead if they don't even know what they're looking at.

      They might have been asking for amiodarone. It is indicated for PSVT, and you have to mix it in a bag before you can administer it.

      Adenosine would have been a quicker choice, but you have to have a doctor at the bedside to give it.

      One of my students, after we went over basic Lead 2 interpretation, caught a 2nd degree heart block (Mobitz I or Wenkebach) that the regular staff had missed.
      They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

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      • #4
        Quoth jedimaster91 View Post
        So me and the PRN tech
        Just curious, but what exactly is an "as needed" tech? Are they on-call for when the regularly scheduled tech is not available? If so, do they get paid for the time they spend waiting to be called in, or only when they're actually called in?
        Any fool can piss on the floor. It takes a talented SC to shit on the ceiling.

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        • #5
          Quoth Sapphire Silk View Post
          They might have been asking for amiodarone. It is indicated for PSVT, and you have to mix it in a bag before you can administer it.

          Adenosine would have been a quicker choice, but you have to have a doctor at the bedside to give it.
          We used to have Adenosine because it was a drug we used for stress tests. But since we switched to Lexiscan, I don't think we stock it in the department anymore. Crash cart would probably have it.

          Quoth wolfie View Post
          Just curious, but what exactly is an "as needed" tech? Are they on-call for when the regularly scheduled tech is not available? If so, do they get paid for the time they spend waiting to be called in, or only when they're actually called in?
          PRN is different from "on-call." On-call does get paid (a piddly amount) for time sitting around for something to happen and then if they do get called in, they get paid more. PRN is basically an extra person to work when needed and not when we don't. They work when we're busy or if someone is off for some reason. They are not guaranteed hours or insurance benefits, but get paid a higher hourly wage to compensate.

          When I worked PRN I could go for months without work and then someone would go on vacation and I'd work a week straight. A lot of PRNs take a lot of call so at least they're making some money. $4/hr to carry a pager isn't much, but over a weekend it adds up.
          Last edited by jedimaster91; 02-12-2015, 10:57 AM.
          I am no longer of capable of the emotion you humans call “compassion”. Though I can feign it in exchange for an hourly wage. (Gravekeeper)

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          • #6
            Yeah, the crash cart would have it. I haven't seen one yet that didn't.

            It's a cool drug. Flat lines you while you're awake to feel the whole thing.
            They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

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