Therapeutic Punching

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The call went out for seizures. I made my way there and the ambulance crew was walking out to meet me in the hallway. The patient looked fine. We got in the ambulance and I got the story straight from him. Apparently he had been experiencing "seizures" throughout yesterday and today. The last one was right as they called 911. The patient though, was totally coherent now, felt a little tired, and could suspiciously remember all of theses 'seizures' (which just doesn't happen to seizure patients.) He said that suddenly he would get a really hot feeling and then would have a seizure.

Mere minutes into describing these events to me, as I put him on the monitor he said, "I think I feel one coming on!" He then went stiff and unresponsive, and the monitor showed ventricular tachycardia, basically a lethal heart rhythm. Before I could even change my pants, he converted back to a sinus rhythm. "Are you okay?" I asked. "Yeah, I'm okay." he answered weakly as if he was trying to convince himself.
Holy hell! I turned to the driver and calmly said "We can go now." as I twirled my finger in the air like a helicopter blade. He got my drift and I asked the EMT to cut the guys clothes off as I got the defib pads out. I quickly explained to the patient what was happening and warned him that he may need a shock. Good God, I can't believe the things I say to people. Basically "If you die again, I am going to shock you. Should work. Should be fun."

Before I got the line in, the patient did it again. I gave the monitor one look and then gave the patient what is known as a precordial thump. A nice therapeutic punch in the chest. In theory, this produces a couple of Joules and can interrupt the VT. I am pretty sure that the EMT thought that I was crazy at that point. The patient converted and I apologized for having to hit him. From there I had about three minutes to the hospital and I got a line started and told the ER what we were coming in with, knowing that if I didn't, they would kill me when I came in the door.

My partner heard my report and came out to greet us in the ambulance bay. The patient went into v-tach again and converted in just a few seconds. I was more than happy to hand him over to the ER. Within five minutes while we were still in the room when he did it again. This time it lasted a little longer than we were comfortable with and we shocked him. Yay, converted again. He was on an amiodarone drip pretty quickly and eventually transferred to a cardiac specialty hospital.

I'm not going to lie, this patient made me the most nervous ever. But it was also pretty awesome!

Here are a few EKG tracings for you.


Comments

Unknown said…
Ellie, I'm no cardiologist (yet), but that looks like TDP to me . . . any chance you could find out what his labs were like?

Andy
22 June, 2008
Anonymous said…
Wow cool! How old of a person was it?
22 June, 2008
Anonymous said…
duuuuuuude
22 June, 2008
PDXMedic said…
Totally Torsades. Give a brother some mag.

Sounds like fun. I'd be wetting myself too.
23 June, 2008
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