Wednesday, January 16, 2013

My apologies, sir

So, I totally know I didn't really cause that patient to go into V-tach. But sometimes you just kinda feel like you did, ya know? Like this morning. He came in complaining of dizziness and a few episodes of syncope. I'm like okay, sure, cardiac monitor, EKG, let's get some labs and an IV placed just in case. 95% of the dizzy-syncope in an otherwise healthy dude just = you probably did too much yardwork and had too many beers this weekend and now you're kinda dry and stood up too fast. But I stuck the #18G IV in and sure enough, he goes "uh, I feel kinda weird" and I look up and the monitor and HOLY SHIT IT'S TORSADES I NEED SOME HELP IN HERE, hit the code button on the wall, people run in and two shocks later he's feeling somewhat better. Better, except for the feeling in his chest like he just got hit by a dump truck. My bad, yo.

So it happens. I can't feel too bad about that. Sure, he just happened to code right when that IV broke skin. But whatevs. I shake it off and move on.

A short while later, I'm getting ready to place a foley cath because he's already peed the bed once - which I can't fault him for, since he did literally get the piss shocked out of him courtesy of me - and I'm not keen to change the sheets again. I'm talking the guy through the procedure, and clean clean clean wipe wipe with the betadine sooner does that catheter tip pass into his urethra and he goes all googly eyed and I look at the monitor again and OH SHIT ITS VT AGAIN I NEED HELP PLEASE. I run on over to the defib monitor, and SHOOOMP he's clear with 200 J of serious business to the heart. More amiodarone, more EKGs, and more apologizing because it feels like someone punched him in the chest.

I know the IV and foley weren't the real cause of those Bad Things happening, but damn. I do feel kinda guilty this morning.


AtYourCervix said...

could he have some kind of weird vagal response to procedures that lead to v-tach/torsades?

Ok, I am so NOT a cardiac RN. But just totally throwing that idea out there.

Shrtstormtrooper said...

He had some crazy electrolyte abnormalities, and did this once or twice without any prompting too. They never did find a concrete cause, but I'm hoping it wasn't me!

Lisa said...

Electrolyte abnormalities prolong the QT interval. It wasn't you.