Is the Spice of Life

It was one of those multi-tasking moments. A new patient was due any minute from surgical intensive care. Another patient was getting a couple units of packed red cells. While going over discharge materials with a patient and their family I heard a call light. And I was waiting on a phone call from the discharge patient's nephrologist to make sure they would also clear the patient to go home.

After excusing myself I went to the other room where a sweet little old lady, admitted with syncope, said she needed to hit the loo so I walked her in. Then my phone rang and while I was chatting up the nephrologist the sweet little old lady sitting on the toilet rolled up her eyes and curled her arms bunnyhop-style.

"So we'll keep him for another night of fluids and get labs tomorrow," I confirmed with the nephrologist, then I said "I'm sorry doctor, actually I'm here in the bathroom with another patient and she's just lost consciousness so if there's anything more I'll call you later," and the very nice nephrologist said "Oh."

I pulled the bathroom call light for help. Like that would do any good. I considered screaming. Sweet little old lady was still out for the count and quivering. Quivering is okay. Dead people don't do that. Much. Well, sometimes.

"Why don't you wake up a little, Mrs. K.?" I asked, and she opened her eyes and asked "Where am I?"

As we walked her back to bed I explained what had happened over the last half a minute. Then my beltphone rang (like I have a batphone or something) and it was the telemetry room calling to tell me that one of my patients just had a "six-second pause." I thanked them saying "Well, that's good to know."

Something like that.

Soon she would be the proud owner of her very own pacemaker. But first I inserted a foley, got some vitals (142/77) and called the doc, who asked us to have Cardiology see her. One of the best cardio guys in the city was on-call; I'd run into him earlier.

Oh... did I say that I put external pacer pads on her and wheeled the crash cart to her room?

Then I gave the bad news to the other patient who had to stick around for another night. They were nice about it.

There are other kinds of asystole. I suppose anytime the ventricles rest you could call it that. A "pause" is asystole that gets better. A lot of people with atrial fibrillation have pauses sometimes as long as a couple/few seconds. That's common enough. Nobody has a perfect sinus pacer node, really.

This sinus node isn't on a great game:

Nothing a pacer can't help. But I'll bet good money that patient never got one, even in Hollywood.

Then there's asystole that doesn't get better, which is therefore more difficult to treat:

You read occasional stories about people banging on the inside of their morgue door or some such thing, but mostly when you see a rhythm like that it's time to dig a hole. Or at least turn off the monitor. After everything else has been tried, if that's the patient's wish.

Another kind of asystole is almost as bad but may get better with pacing:

The pacer node is trying to get through to the ventricles but the message is lost in the mail.

The same thing sometimes happens to me a lot. But the message instead gets lost somewhere between my brain and my mouth.

One's from a dog.

The nephrologist stopped by late and let us send that other patient home, after all.