Our worst nightmare. I ended up in my own ED! Saturday after Thanksgiving went in for an afternoon shift and about 4PM went into PAF. Has happened maybe 4 times in 10 years and has always gone away with rest. So I finish the shift out and go take something to sleep. Had to get up for at 10AM Sunday for new shift(great clock rythym there)Still felt it. By the time I walked into the Hospital I felt like shit.
One of my buds(nurse) made me go to a room and did an ECG..130-140 AF, bp a little crappy..
So one of my partners comes in and shames me into signing in, gives me some diltiazem and I slow down but don't convert..Finally after a few hours a couple a cardiologists show up to give me shit and I convince them to cardiovert me. Had to direct my own concious sedation to start, then ask my charge nurse to go get a real doctor in case something happened(my partners)
I get zapped not once, but 4 times(I think) the last 2 with 360 and the last one apparently with a Cardiologist putting a paddle over the pad to get enough pressure to get thru my chest(for those who don't know me, I'm ex-athlete, 6'7" 290)
Man that really gets you sore! Felt like I'd done 5000 benchpresses. My damn chest hair hurt for 3 days! The nurses all felt bad for doing it to me, but at least it converted and I'm still in NSR.
Overall, I wouldn't recommend it...But if they send me a PG, I'll give us high scores!!
Sunday, December 02, 2007
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I've seen a few cardioversions where I used to work. They were done in a small procedure room and we would try to get a peek through the not quite closed curtains to satisfy our morbid curiosity.
ReplyDeleteOUCH! They always looked soooo painful! And how bizarre to have the patient only under conscious sedation, made it appear more like tourture than therapy.
And you, got the full 360, yikes!
Hope your chest hair feels better soon and you remain in NSR.
Wow, you are a big guy. Did you feel SOB or did you feel like shit just from hypoperfusion? One of our hospitalists gets this from time to time and we sedate and shock him and he goes about his business. Hope you are doing fine.
ReplyDeleteCAT
Hope you're okay, Sparky.
ReplyDeleteOut of curiosity Oldfart, Community?
ReplyDeleteIf you don't get that, nevermind.
Glad you're feeling better.
emergencyem...I think your answer is yes, medium size community hosp..
ReplyDeleteThanks for all the "heart" felt good wishes, you Blog addicts..
Oldfart shoot me an email sometime. emergencyemm@yahoo.com
ReplyDeleteSorry you feel like you've been run over by a Mac truck - thoughts for you:
ReplyDelete(1) Consider Ibutilide 1 mg over 10-15 min to see if that would chemically cardiovert you before cardioversion next time. (Can repeat once after 10-20 min, if no excessive QT prolongation on your EKG).
(2) Be sure your patches are AP (over the breast bone and back behind the scapula and have the doc ALWAYS apply pressure (place a DRY towel over the patch while pressing).
(3) Be sure the defibrillator used is a biphasic defibrillator (older ER's use monophasic defibrillators which suck at converting afib relative to biphasic devices)
(4) Consider an anesthesiologist - ;)
Best of luck to you. Hope it's not a recurrent theme...
One of my buddies is a 6'7" ER doc in Texas, but I don't think it's you. There can't be many with those specs though.
ReplyDeleteI think I'd choose Corvert too. But after 18+ hours of afib, shouldn't you have been anticoagulated or gotten a TEE prior to cardioverssion by any method?
It looks like the current recommendations are that it's OK to cardiovert if the duration of AF is less than 48 hours. I remembered it being <6 hours.
ReplyDeleteScapel..I've taken as ASA daily since I was in med school back in the 70's. Just seems like a good idea if no contraindications, for EVERYONE..Kept my Dad from CABG til he ws 80 and then he just had little old man arteries, no focal plaque disease..So I was plenty anticoagulated along with a well balanced 2 carbon fragment intake..Probably not but 1 other ED doc my size and he was one of my medical students in the very early 90's
ReplyDeletedrwes..Corvert is not that great in my experience and I've used it a lot since 98, but not much in a couple of yrs..Pads were A-P..Didn't realize how big my chest was(WTF, I wear a 56XL Jacket!) and will know how to apply the juice as you suggest..Don't believe bi-phasic any better than the old, but have used it..And any ED doc worth his salt is as good at ConSed, maybe better, than an Anesthesiologist(there I go pissing off some more folks!)but thanks for your ideas, I think I had them considered and covered, even the Corvert, just rejected it..If I had to do it again, I'd still cardiovert, despite Dr Cheung from Philly, who wrote the book on AF and said "for AF, cardioversion is treatment of choice, EXCEPT for Dr Cheung, treatment is Dig!" HAH!!
Oldfart-
ReplyDeleteAlthough ibutilide might not be so great at converting you back to sinus alone, one study demonstrated improved efficacy of cardioversion with ibutilide pretreatment.
Might be worth a shot if they have trouble next time.
All the best-
oldfart,
ReplyDeletedid not mean to offend, sir. hope you are less sore and back at the game. kinda like a mule kicked you huh? hope they gave you good drugs!
Sorry to hear about your AF. Also sorry you weren't in MY ED I'd have fixed your ass up big time...no charge!
ReplyDeleteYou'd never have felt a thing. You might be on the organ donor list right now, but still, you'd never have felt a thing!
Love ya big guy and hope you're doing better. Knowing you, you haven't missed a shift!!
To etotheipi: no, he's not Shaq. He can actually make a free throw!