The call is for a man’s defibrillator going off.
When we arrive, it has gone off four times already. I put him on the monitor.
“No wonder,” I say. “It looks like v-tach” to me.
Then all of a sudden, he cries out as his whole body convulses in pain.
(The artifact was caused by the wires moving as he reacted to the jolt.)
His internal defib shocks him once more before I can get the line in and start giving him some 150 mg of Amiodarone over 10 minutes.
Here’s the initial 12-Lead:
Shocking is incredibly painful. This guy, who even though he was diaphoretic, was joking with us, and then when the defibrillator went off, his whole body winced in pain, and he started cussing at me to hurry up and give him the medicine. I also gave him some Versed, and then hung an Amio drip at 30 mg/hr. He didn’t get shocked again and felt much better.
His final rhythm was hard to determine. I still called the underlying rythmn v-tack. The axis was still about 215 degrees (Extreme right axis deviation). The rythmn was very funky, but his rate slowed from the 150s to 100 and he was perfusing better. It was irregular. His wife said he only had 1/3 of a functioning heart.
In the hospital his rate was down in the 80′s and showed his pacemaker kicking in. They ended up admitting him.
***
I have done quite a number of these calls over the years — it seems with increasing frequency (probably due to more people being equipped with them). Now at least we can give them Versed to sedate them a little and hopefully later forget whatever pain they feel when the thing goes off. Also I believe the amiodarone is a great improvement over the lidoicaine.
Once I did a patient who was testifying at the state capitol when he was shocked. He tried to continue, but got shocked again. (I can think of some people testifying I would love to have a button to give them a a little jolt when they tell lies).
I read once about a man who had an internal defibrillator. He was in his thirties and had several children. His defib was going off over 200 times a day. Nothing the doctors could do could get his rythmn under control. After months and months of agony, he finally asked to die. They turned his defib off and he died with his family around him.
and nobody had a cow about him wanting to have his defib off? yet schiavo…
Regarding Versed, and any sedative/analgesic, what often gets overlooked in medicine, particularly pre-hospital care, is how important patient comfort is on long-term viability of a person. Pain causes stress. Stress causes pain. Both pain and stress inhibit one’s ability to heal. There’s no shortage of research on the subject of a patient’s ability to heal and the level of stress they experience. Pain is a sign of some dysfunction in the body. Nobody is oblivious to this, especially the person in pain. What that must mean to someone experiencing horrible pain is that their body is failing them in a grand fashion. People in horrible pain will often wish for death. That’s how powerful pain becomes. It reminds us of our failing body in a bold and unavoidable way. This causes such anxiety and grief that it only exacerbates the stress, and thus the pain ultimately at the detriment to patient outcomes.I am of the opinion that early, frequent, and effective steps to reduce pain can lead to better patient outcomes. One of the failing of EMS is focus on keeping the patient alive long enough for definitive treatment. That’s not good enough. We should be concerned not just with patient care to the point at which care is transferred, but also to the patient’s discharge from the hospital.
I can’t see the images for the ECG’s anychance you could attempt to fix it cos the thumbnails looked interesting, and er kinda scary!! Cheers M
Wow. Nice V-Tach. Love how the Lifepak calls it everything. EXCEPT V-Tach. Anyway, what’s the big differance between the amiodarone for sustained VT and the lidocaine for sustained VT? Our protocols still say lidocaine.
1. I tried to fix the problem with the ECGs. I don’t know if its working for you or not.2. Under the new AHA guidelines, amiodarone is the drug of choice for regular wide complex tachycardia or uncertain rhythm.“Evidence in support of amiodarone comes from 3 observational studies that indicate amiodarone is efective for the termination of shock-resistant or drug refratrory VT. One randomized parrell study indicated that aqueous amiodarone is more effective than lidocaine in the treatment of shock-resistant VT…”-2005 AHA Guidelines IV-73Expect your protocols to change by the first of the year.