Wednesday, May 23, 2007

Internal Electricity

It's the middle of the evening. My laundry list of horrible things to do to patients has rapidly been depleted. The board is emptying quickly. At this rate, we're either going to be bored for the next 8 hours, or there's going to be some sort of gnarly MCI because too many people said the "Q" word.

On the front side (where the real patients go), we have a sweet little old man who came in via EMS for a syncopal episode. Upon arrival, all his vitals are normal, he's embarrassed, and he wants to go home. His wife is keeping him here by sheer power of guilt trip.

He has a fairly significant cardiac history, so the doc ordered a full workup, and since I have literally nothing to do, being the helpful Monkey that I am, I head in to stick a needle in him.

I've got the tourniquet on, the site prepped, and I'm ready to poke him when he starts coughing. Coughing + needle = blown vein most of the time. So I wait a minute. He stops coughing. I return to said site. Veins are now flat. In fact, patient is starting to look like shit awful quick-like. I look up on the monitor and he's in v-tach.

A lot of things happened really fast at that point. First of all, my anal sphincter did the proverbial "crack a walnut" squeeze. I put the head of his bed down and felt for a pulse. (Which was not really necessary, since he was complaining about being poked again, but still the first thing I did.) Then, as I went around the bed to hit the "take BP" and "record strip" buttons on the monitor, I got on the radio and said, "Could somebody bring a crash cart into room 5, pretty please?"

One of the paramedics that was walking by stuck his head in to see what was up and I said, "He's in v-tach." The patient, who had been whining about his bed being flat, says, "I don't feel so good." I reach for his wrist again, and all of a sudden he does the internal defibrillator flop. (Not nearly as entertaining as the external electricity arch, but much safer for the innocent Monkey holding his wrist.) It startled me enough that I might have let a little poo go if my anus hadn't been squeezed up so tight!

I look at the monitor: normal sinus. I look at the patient: he's glaring at me like I just killed his dog. I said, "What?" To which he replies, "What'd you do THAT for?"

I said,"Sir, I didn't do that. The defibrillator that you have implanted in your chest did that. I just watched." (Though it would have been nice if it had done it about 30 seconds earlier!)

About now, the cavalry arrives with the doc and the crash cart. We twittered around for a few minutes, but apparently he was "fixed" for the time being. His vitals were back to normal again, but he was now officially staying for breakfast. (And we all know that breakfast is the only semi-edible meal in the hospital.) I went back to my previous task, which was much easier now that his veins were the traditional round shape, not flat as pancakes.

Note to self: Bring a change of underwear to keep in locker. Sphincter control may not always be so reliable.


Alexis said...

Those internal defibrillators are scary (but cool). I was in a public place with a team of do-gooders on morning when someone's internal defib went off several times in succession. From a distance it looked like something horribly nasty and electric had jumped up her sphincter. I wasn't within 50 yards, but I heard someone yell for me: "Hey! You're a med student! Get over here!"

Now that you're done laughing at the absurdity of calling a medical student over to take care of anything, let me tell you that I never ever want to hear someone shout that again.

Needless to say, I took her pulse, made her sit in the shade, and offered to call 911. But I'm glad she had the defib, because my CPR skills are very very rusty.

X-Ray Geek said...

Extra pair of underwear in the locker is always good! I've actually been on "poop patrol" for one of my friends because of course she had on white scrub pants during the time of questionable sphincter control. I usually have an extra pair or two in my locker:)