Ignorance is Bliss?

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We arrived on scene, Fire was already there with the patient.  I was informed this patient was having shortness of breath, felt dizzy and had blurred vision.

Patient:  “I have Wolf Parkinson’s White Syndrome”.

I’ve only ever had one patient with this syndrome before, it affects the wiring in your heart and can cause irregular heart beat.

Me:  “When did this start?”

Patient:  “Maybe 15 minutes ago?  Normally it only lasts a minute and it goes away, this is the worst I’ve ever had it.”

I checked his pulse and it was rapid and irregular.

Patient:  “It got worse when I walked, my vision got blurry and I was very dizzy.  Right now I have tingling in my left arm and my face.”

The patient was otherwise young, healthy, takes no medications and had no caffeine.  There was nothing he could tell me that may have precipitated this.

At the hospital, the doctor saw him right away.  I noticed his heart rate continuing to increase, on scene it was around 107, now it had gone to 150, then 187, and later 245 beats per minute.  It was obvious they needed to reset his heart quickly.

Doctor:  “We need to reset your heart, it’s called cardioversion.  We will have to put you to sleep for that procedure because we need to shock your heart.”

Patient:  “Cardioversion, what is that like?”

Doctor:  “It’s like me punching you in the chest really really really hard.”

Patient had a funny look on his face as if contemplating.

Patient:  “Ohh cool, can I be awake for it?”

Did I forget to mention our patient was a super chill guy?  Maybe just… too chill.

Doctor:  “Oh no, I won’t let you do that.”

The doctor looked at me with the expression:  Is he crazy?

I chuckled a little inside.  Our patient had no idea what cardioversion was like, and had never seen it, so he doesn’t see the image of a person tensing up in pain from a jolt of electricity passing through his heart.  That’s definitely not something I want to be awake for, in fact, it looks painful even when patients have it done under anesthetics.

So the nurse drew up the medication as the doctor prepares for the procedure.  My partner and I decided to stick around because it is always interesting watching a cardioversion, and also in case the doctor and nurse needed an extra hand.  Once the patient was sedated, everything was ready to go.  The pads were connected, and now was the moment.

Nurse:  “How many joules to start?”

Doctor:  “200 is good.  Ready?”

Nurse:  “Yup, whenever you are.”

Shunk!  The shock was delivered, we watched as our patient’s back arched slightly and then sank back onto the bed.  We watched the ECG monitor as our patient goes into asystole, or flat line.

asystole

I could feel the atmosphere in the room get heavier and heavier as we waited…

asystole2 

And waited… 

asystole2

And waited…

asystole2

Is this really supposed to take THIS long for the heart to restart??

The nurse looked at me, and we all looked at the doctor, the doctor looked right back.  We all knew things weren’t quite right.

Doctor:  “Start CPR.  NOW.”

Immediately I started chest compressions.  I looked at my patient’s face, he’s so young. 

Common!  Don’t die on me! 

My partner goes to the head to start bagging the patient, while the nurse grabs the crash cart and starts delivering medications at the doctor’s order.  Every now and then we checked the ECG monitor and checked for pulse.  More epinephrine went in via IV.  His eyes were rolled back, glazed, dead.

We ran as a well oiled team, everything was going smooth, now all we needed was for our patient to do the same.  To wake up.

After what felt like eternity (it couldn’t have been more than five minutes), we finally saw the ECG peaking and falling in a perfect sinus rhythm. 

Thank goodness!

The heaviness in the trauma room seemed to slowly lift, a thankful relief.

The patient wakes up shortly after.  He looked a bit drowsy, but his eyes glistened with life.  So different from those glazed eyes just moments before.

Patient:  “Hey…”

Me:  “Hey, it’s all good, you’re okay.”

Patient:  “Oh, what happened…”

Me:  “We reset your heart.”

Patient:  “So it’s all done now huh?  You restarted my heart.  That’s SO freaking cool!”

Oh my gosh you have no idea, you just woke up from the dead.  You DIED just a moment ago.

Me:  “Yeah no problem.”

Patient:  “My chest is a bit sore.”

No kidding!  I was pounding on your chest!

Me:  “That is pretty normal.”

Patient:  “Man that’s so wicked what just happened.

He has no FREAKING idea…

Patient:  “So you and your partner decided to stick around huh?  Was it to learn?”

Me:  “Yeah that and just in case they needed an extra hand.”

Thank god we stuck around!  It was all hands on deck.

Patient:  “So can I go home now?”

Completely oblivious… I suppose it’s a good thing.

Doctor:  “Ah no… There was a…complication when we reset your heart.  You will require more monitoring and you need to see a cardiologist for consideration for ablation of the accessory pathway of your heart. “

A complication.  Well put.  Not: YOU JUST DIED!  Best not break him the news about what happened quite yet.

The patient and I continued to chat for a bit, I did my best to avoid telling him he went into cardiac arrest.  After all, if the doctor didn’t feel like right now was a good time to tell, I wasn’t about to go about delivering that news.  I couldn’t stop looking at him and his big smile.  He had no idea what had happened, he was so bubbly, completely oblivious to it all.  He just thinks what we did was so cool.  I would beg to differ, but hey, I’m not going to burst his bubble.  It’s good to see him talking, and… alive.

Patient:  “Thanks again, you guys were awesome.  That was pretty cool what you did.”

Me:  “No problem, you take care of yourself.”

That was a bit of a strange call, it was strange in the sense that we technically killed the guy, and then brought him back.  It’s not often you’re the one inducing cardiac arrest, I suppose that is the risk one always takes when you cardiovert a heart.

 Today I witnessed the truth to the saying:  Ignorance is Bliss.  Nothing more true than that today.

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Comments
9 Responses to “Ignorance is Bliss?”
  1. Marc Hollinshead says:

    Great ROSC guys if not a little eye bulging !!

  2. I’m just past halfway through my PCP training at the JI. Been reading your blog since EMR last year. Cannot wait to get out there…..

  3. Justin says:

    Hi there,
    Starting my degree in Paramedicine this year in Australia.
    If you would be down for it, it would be cool to compare procedures,equipment and services with you. As well as getting advise on what i am doing in my course at the moment!

    If not, no harm done but it would be good 🙂

    Thanks mate,
    Justin.

    • PocketMedic says:

      Hi Justin, I haven’t been keeping up to date with my blog as you can tell. How are your studies going? I remember there is a good documentary about paramedic students in Australia. I’d be more than happy to talk about paramedicine with you, I’m just rather slow on replies sometimes.

      Cheers

  4. Allie says:

    I just wanted to say a huge thanks for you blog. It inspired me a little over 1.5 years ago to follow my dreams of becoming a paramedic….. and this has helped me prep for the JIBC PCP program, my BCAS interview and many other things. Now I can officially say i am a PCP newbie with BCAS. This has inspired me so much and given me strength and courage when i wasn’t sure if I could handle the path. Thank you so incredibly much and I always look forward to the next post.

  5. snakemedic says:

    Hitting the nail on the head, if they only knew what happens when the lights go out in their mind.

  6. snakemedic says:

    Reblogged this on snakemedic and commented:
    In case you ever wondered what really happened at work when you ask, “how was your day?” and the response is, “same old, same old.”

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  • Courage is the discovery that you may not win, and trying when you know you can lose. -Tom Krause
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