V-fib

[The White Coat Investor]

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What's your record for shocking someone out of V-fib? We had a guy show up with an LAD STEMI last night, went into V-fib the second he rolled into the treatment room. Over the next 30 minutes before he rolled to the cath lab he was shocked out of V-fib no less than 14 times. The LAD was completely blocked. It got so routine the nurses were doing it on their own while the docs were going in and out of the room arranging things. The poor guy wouldn't be in it more than 10 seconds before he was shocked out again-which, of course, means he was CONSCIOUS for most of the shocks. I told him "Sorry about all the electricity, but it's what's keeping you alive right now." (We did give him 10 of morphine.) He kept going into V-fib despite amiodarone AND lidocaine boluses/drips.

So....14, can anyone beat that?

 

[jbar]

Maybe some versed would have helped him forget the shocks.

 

[Hamhock]

the next 30 minutes before he rolled to the cath lab he was shocked out of V-fib no less than 14 times.

30 minutes of this? Did you consider thombolysis (even with a cath lab waiting) since you can't keep him out of Vfib?

Not sure what I would have done, that's why I am asking.

HH

 

[emd123]

What's your record for shocking someone out of V-fib? We had a guy show up with an LAD STEMI last night, went into V-fib the second he rolled into the treatment room. Over the next 30 minutes before he rolled to the cath lab he was shocked out of V-fib no less than 14 times. The LAD was completely blocked. It got so routine the nurses were doing it on their own while the docs were going in and out of the room arranging things. The poor guy wouldn't be in it more than 10 seconds before he was shocked out again-which, of course, means he was CONSCIOUS for most of the shocks. I told him "Sorry about all the electricity, but it's what's keeping you alive right now." (We did give him 10 of morphine.) He kept going into V-fib despite amiodarone AND lidocaine boluses/drips.

So....14, can anyone beat that?

50 or more is my record. Lady on ER rotation in residency. Her AICD shocked her 30 plus times. Awake for about the first 20-25. The battery actually ran out and it stopped shocking. Shocked her 20 plus more times manually and finally got a rythm. Went into PEA for 1 minute of CPR. With one dose of epi, got pulse back and never lost it again. Pt left the hospital with full neuro status. Couldn't believe it. One of the most unbelievable things I've ever seen in my career. Its probably reportable but I never wrote it up. Called her at home as one of my required patient follow ups and she was mad at me. Said "The stupid thing [AICD] won't let me die in my sleep! I always wanted to go quietly in my sleep! Can you take it out!" The craziest thing about it at the time was the attending left the room and let me flap in the breeze after the first 30 shocks thinking there was no way the patient could live. Unbelievable but 100% true.

 

[gramcracker]

We had 56 in one of our cath labs, refractory to lido, amio, procaine. Cards finally cooled the guy and he stopped.

 

[The White Coat Investor]

30 minutes of this? Did you consider thombolysis (even with a cath lab waiting) since you can't keep him out of Vfib?

Not sure what I would have done, that's why I am asking.

HH

No, didn't think about it. Probably would have been reasonable. But with a cath team assembling and easily getting him back out every time, probably wouldn't have done it even if we'd thought about it.

The guy goes home today. Super grateful. Almost as grateful as the emergency doc across town who saw him earlier that day and sent him home with an outpatient stress test lined up. 😱

 

[WilcoWorld]

Almost as grateful as the emergency doc across town who saw him earlier that day and sent him home with an outpatient stress test lined up. 😱

gulp