Dispatched for yet another sort of vague chest pain complaint. The patient was an 80 something year old lady who awoke with chest pain unlike anything she’s had before. She looked uncomfortable, but seemed to be perfusing well. BP was 280/90, HR was, uh, fast. I figured it around 150 or so because when it gets up that fast it gets hard for me to count. Respiratory rate was 28, which is a bit worrisome for a lady of that age range. Her Oxygen saturation was a totally unhelpful to our diagnosis 100%.
We applied the monitor and found a SVT at about 160, which we decided might well be Atrial Tachycardia. Might not be, though, so we took the safe route of administering Diltiazem. My partner worked on starting the IV while I worked on mixing up the drug. We get ours as a powder that we mix with liquid and then inject slooooooowly into the patient.
Well, that was the plan, but the patient’s veins weren’t cooperating. She had pointed out the “best” vein to my partner, but his attempt to get a tiny 22 gauge IV in didn’t work. We decided it was time to move to the ambulance where the lighting was (much) better and try again.
Which is the point at which the patient’s cardiac conduction system took matters into it’s own hands and did this,
And of course this happened during the one nanosecond we were not looking at the monitor or the patient. Why the rhythm broke is as much as mystery as to why it started in the first place. Nothing in her history or medication list suggested this sort of thing. The best thing about it was that as soon as her rhythm broke and heart rate dropped back to normal, her chest pain went away completely. I can’t take a bit of credit for that, not one bit at all.
We took the nice lady to the hospital where I relayed the story to the medical staff. I also suggested that maybe it was a case of alien abduction, where they beam up our patient and beam down an exact duplicate that has a different cardiac rhythm. They weren’t buying it, but I think it’s as rational explanation as anything else.
Did you scare her in the process of moving her to the bus? Maybe you talked about Obama’s “plan” for Medicare and that knocked her back into a (more) normal rhythm…
No, she was just lying on the stretcher while we were getting ready to move and the rhythm changed. I wasn’t constantly watching the monitor as we had equipment to pack up, keys (hers) to find, and other things to do.
Had one of our old guys come in last week when I was duty supervisor and ask about his “uploaded ECG”. Similar thing…had a gal with a rate of over 200 on the monitor, didn’t feel well. Before they bothered to hit “print”, they helped her lay down in a more comfortable (and less dizzy) position, and the rhythm broke. Despite 30+ years on the job, the residents were unimpressed with such a tale (when the printed ECG showed a NSR). So, he stopped by, I pulled the chart and printed off that segment of strip and he went back to watch the new residents eat crow.
Weird how patients do that sometime.
We had plenty of paper, but not of the moment when the rhythm broke. We gave the hospital “before” and “after” rhythm strips and 12 Leads. I should edit the post with those so everyone can see how different they look. Maybe later if I get a chance. I really need to get a flat bed scanner so I don’t have to borrow the Mrs’ all in one printer.
I was able to grab that screen shot off of the ePCR computer before I uploaded everything to the server. Once it’s uploaded, it’s no longer accessible to the field crews, which I understand, but don’t always like.
I said ‘atrial tach’ to a resident one time, and got the strangest look. “There’s no such thing,” he said.
Psshah…
He was a resident, we wouldn’t expect him to know better. Unless he was a resident in cardiology, emergency medicine, or well, medicine.
I’m more interested in the fact that you can still get your hands on the powder-form Dilt. I thought they stopped making it??
It’s not the Lyo-Ject that we used to get. It’s vial of powder that screws into a bag of Normal Saline, is mixed, and then we have to draw out. It’s something the hospital puts together for us. I wish we still had the prefilled syringes, but apparently they weren’t profitable.