OK. This happened yesterday.
"WE NEED A DOC IN 20."
I'm around the corner and pop in. I see a pale 50ish yo woman minimally responsive in VT with a rate 210 on the monitor. Nurses just transferred her from the EMS gurney onto ours. She looked like a ghost.
"We need to zap her now. Get the zoll."
Pt ain't talking, just mumbling. I don't even really bother with an exam. I direct nurse A to put on some O2, nurse B to establish IV access. Nurse C is getting a zoll down the hallway. 2 minutes and 200J synchronized juice later, I get her into some sort of funky, non VT rhythm on the monitor. Pt wakes up a little and is pissed because she's in pain from the shock. One minute later back into VT again, it now appears polymorphic. More juice. I ask for Mg 2g and amiodarone 300 mg. She gets out of it, and then pops back into VT and I juice her again.
After three or four shocks she is stablish and yelling "dont do that again! That hurts!" She's ripping off the O2 and not being particularly cooperative. "Let's tube her" I quip.
EKG looks like this. Not actionable in my mind at this second. At this point there are 10 RN's, techs, and RT in a tiny room. Things are actually going OK though...and I talk to her and she's cooperative. She's a diabetic and appears to have psych disease based on her speech patterns. I actually call off intubating and.....
...back into VT.
200J synchronized again. For the next 40 minutes, she passes through every rhythm. VT, VFib, PEA, back to VF, and was ultimately in VF for like 25 minutes. We even dual sequential defibbed her several times. Nurses be like "THIS IS COOL" By the end of the resus...she received amio 300 and 150, epi x3, sodium bicarb x3, calcium x1, lidocaine 100 x2, lopressor 5 x2, and IVF x2. Tubed too. Cards was at bedside and very helpful, although ultimately we both didn't know what was going on. Bedside echo showed no pericardial effusion, more or less mild hypokinesis, and a normal RV. I slam in a semi-sterile right femoral TLC and start her on 20 levo. All her blood work came back and it's basically normal. At this point I've decided to make her DNR. If she codes again we can't keep on doing CPR. Especially after about 50 minutes of it in the ED. Nurses start to slowly slip out of the room. Everything calms down. To the remaining ones in the room I remark on their good work and say "if she walks out of this hospital, I'm buying french fries and beer for you guys". 5 minutes later....
"DOC we need you in 2". I forgot about this pt I saw 1.5 hours ago her during the resus above. She's an old, moribund, debilitated, bedbound, obese uroseptic F with pus in her bladder. She looks just like a
@RustedFox special he sees every day. Pt's on peripheral levo @ 20 with a BP of 100/40. I put a L IJ in her and give more fluid and more drugs. Easy admit to the ICU.
1 hour goes by. I scan bed 20. CTH normal, CT PE neg, CT A/P neg. We only gave her 1 broken rib. Good for us.
Second EKG is again blah. Called ICU and they will start cooling upstairs.
"DOC, we need some sedation for Bed 20."
"WUT? What do you mean?"
"She's mouthing words and following commands!" I believed the nurse but I didn't. She's been quasi critical stable for the past 1.5 hours. I go into the room and talk to a tubed patient and she's nodding, blinking and squeezing my hand once for no, twice for yes. UNBELIEVABLE
I suspect I'll be out several hundreds of dollars sometime later this month.
