Sphincter Tone

Today was my last day on the Trauma service until the spring. I was up in one of the hospital wards seeing a patient, when one of the patients a few beds down started having runs of v-tach (or ventricular tachycardia). This is a heart rhythm that, if sustained, can kill you.

Now I was standing a few feet away and heard the nurses talking so I came over and saw that it was true, and people were starting to get a little wound up because again, v-tach = bad. The nurses called the patient’s doctor (I have never met the patient before), but being the closest doctor on hand I felt some obligation to do my doctor thing. So had the nurses put the patient on the heart monitor/defibrillator, stick a non-rebreather mask on him, draw labs and monitor his blood pressure. Everyone was kind of wound up because he’d have these runs of v-tach, then he’d snap out of it again. The runs weren’t much longer than maybe 20 or 30 seconds, but when it’s a potentially fatal arrythmia, it’s scary. The patient himself was groggy and not really with it, but he was conscious. I was more or less keeping one eye on the monitor and the other on him, because if ever it got bad enough that he lost consciousness/lost his pulse, we’d need to shock him and start CPR.

It was about at that point that I took out my little book that I carry with me to look up the amount of energy that we’d need to use to shock him (turns out it’s about 120 Joules), and to remind me as to what additional steps we’d have to take if indeed he lost his pulse, but I had to laugh at that point because I was literally flipping through the proverbial textbook to find the answer to this real life question. Good thing no family was there to see me.

Anyway, he’d have these runs of v-tach and then snap out over and over again for what felt like forever. Finally his doctor (someone who knew something about the patient) showed up, he called the medical ICU and sort of took over.

I’ve practiced this sort of scenario on mannequins a fair amount. But I’ve never been in this scenario before where I was in the position of having to run the thing on a real patient (I’ve been other doctors’ helper-minion many times, but never in the role of the one in charge).

The patient made it up to the MICU safely, I didn’t do anything terribly stupid (although in retrospect I could have done some things that might have been smarter), and yeah. It scared me shitless.

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