Modern medicine really amazes me.
When telemetry calls me and tells me my patient is in SVT, and I just stepped out of the room, my initial reaction is “Are you sure it’s not artifact?”. Which is a natural response, even though I know she wouldnt waste her breath and energy on calling me if she wasn’t pretty darn sure there was a reason to. When I walk back in the room to assess the patient, she is fine, well, at least, she appears fine, asymptomatic and all. The pulse oximetry is reading her heart rate at 110, which is what she has been running the last 2 days. So of course, I ask her again “Are you sure?”
Without seeming even remotely frustrated, she responded “I wish I wasnt, but she’s being doing this for a few minutes now”.
I assess her. Placing my stethascope on her chest I auscultate her heart: irrgular, irratic, bounding, and much higher than the 110 that is appears to be, according the bedside monitor. All the while the patient continues to talk and appear fine.
She converts to AFib and sustains at 170. By this point I am paging the physician. Poor non-cardiologist, he immediately consults a cardiologist. I sqeeze an EKG and cardiac enzymes out of him before the call is over. Cardiologists orders a Cardizem drip with a bolus.
I renter the room, at this point the patient is in distress, and appears anxious, and says she feels like her heart is racing. The monitor reads 150s at the bedside. I scan the patient, the medication, draw up the bolus, prime the IV with the Cardizem drip and begin to push the medication slowly. I flush the line. I connect the drip and start the infusion.
Withing a minute, I see a look of anxiety replaced with a look of releif. I watch a heart rate fall from 160 to 95. I stop a potential heart attack with 4ml of fluid. And maybe its just the fact that I’m a huge nerd, but to me, the fact that 4 ml of fluid can skirt a potential disaster, is pretty darn impressive.
Its moments like these that remind me why I choose nursing. The doctor may have wrote the order for the Cardizem but I GAVE the Cardizem and I had the priveledge to provide a potentially life saving intervention.
I think is pretty cool that is a part of my job.
- Posted using BlogPress from my iPad
I love Cardizem too
Twitter: thenerdynurse
says:
it just works! I bet Martha Stewart is a fan…maybe even Apple.
You rock!!! And yes, it is amazing that 4ml of fluid can change the near future in gigantic ways!!! I am always impressed when I shove an NPA in a nostril and it avoids respiratory arrest! Booyaaa!
Twitter: thenerdynurse
says:
it really is incredible to feel that impact. Its a feeling of relief, excitement, and pride all at once. Truly, a reward from healthcare that I hadn’t even considered when I picked the profession of nursing.
Nice when it works. Makes the sphincter tighten a bit when you push the bolus and NOTHING happens. Or the heart rate goes up…
Great post enjoyed reading it.
Consider cardioversion