My first day on rounds we arrived in the MAPU (medical assessment and planning unit) to find an excited nurse telling us that our new consult had a heart rate of 220/min. The patient was stable and in no acute distress so we gave him a 12mg IV bolus of adenosine. The patient blocked down to a 4 to 1 conduction with clear atrial flutter waves on the monitor. Due to the short half life of IV adenosine he quickly shot back up to a ventricular rate of 220/min. We talk about giving him IV midazolam and shocking him with 50 joules at the bedside (my suggestion). Instead we called anesthesia who wanted him taken to the OR and intubated so they could protect his airway as he had just eaten breakfast. So we started a IV infusion of amiodarone and it was off to the OR with our patient for urgent cardioversion. In the OR we changed into scrubs and arrived to see the anesthesia staff administering IV propofol and preparing to intubate the patient. We quickly hooked him up to the biphasic cardioversion device placed the paddles on his chest, synced to the ECG trace and set it to deliver 50 joules. I looked over and saw his blood pressure had dropped to 70 systolic and stated we better shock him back to sinus now. I turned to see our Cardiology Registrar who was going to perform the cardioversion had on a mask that he had been handed by the house-staff (Kiwi sense of humor). C shouted clear hit the button and the patient returned to sinus rhythm rate of 70/min, blood pressure returned to baseline and we were off to finish rounds. So thats the end of excitement on rounds. Kia Ora from New Zealand.
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| The Masked Registrar |
My first day on rounds we arrived in the MAPU (medical assessment and planning unit) to find an excited nurse telling us that our new consult had a heart rate of 220/min. The patient was stable and in no acute distress so we gave him a 12mg IV bolus of adenosine. The patient blocked down to a 4 to 1 conduction with clear atrial flutter waves on the monitor. Due to the short half life of IV adenosine he quickly shot back up to a ventricular rate of 220/min. We talk about giving him IV midazolam and shocking him with 50 joules at the bedside (my suggestion). Instead we called anesthesia who wanted him taken to the OR and intubated so they could protect his airway as he had just eaten breakfast. So we started a IV infusion of amiodarone and it was off to the OR with our patient for urgent cardioversion. In the OR we changed into scrubs and arrived to see the anesthesia staff administering IV propofol and preparing to intubate the patient. We quickly hooked him up to the biphasic cardioversion device placed the paddles on his chest, synced to the ECG trace and set it to deliver 50 joules. I looked over and saw his blood pressure had dropped to 70 systolic and stated we better shock him back to sinus now. I turned to see our Cardiology Registrar who was going to perform the cardioversion had on a mask that he had been handed by the house-staff (Kiwi sense of humor). C shouted clear hit the button and the patient returned to sinus rhythm rate of 70/min, blood pressure returned to baseline and we were off to finish rounds. So thats the end of excitement on rounds. Kia Ora from New Zealand.
Shocking!
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