Tuesday, May 8, 2007

It's a little fast......

A brand new hospital is being built for us. Completion time is sometime next summer. In the meantime, the attitude is, "If it's broken, just hang in there; the new hospital will have one that works."

I purchased (out of my own very pathetically lined pocket) a nice, expensive portable pulse ox because none of the ones in the ER work. It has paid for itself in the 3 months I've had it. I'm still a bit pissy about the expense, but like I said, in my mind, it was worth it. Case in point....

A couple of nights ago we had a guy come in complaining of weakness (Busy, busy). I slapped my cute little Nonin on him and it showed a rate of 195. Go figure, he was feeling a bit weak. I called to the back on my handy-dandy walkie-talkie for an empty bed, and then on the way back to said bed, called for backup. (No, don't backup!) My charge nurse said she didn't have anyone who could help me right then, to which I responded (in my usual sweet, courteous manner) that my SVT guy was sicker than her drunk guy and she needed to come help me. A couple of other people (including the Doc) copied my oh so very polite traffic on the walkie-talkie, and by the time I got him to the back, they were hanging out waiting. From that point on it was like Buttah, Baby. Smooth. In less than 5 minutes, we had him hooked up, EKG'd, IV'd, and were giving him drugs. In less than 10 minutes he was normal sinus at a rate of 75.

Now, I always get a little stressed at SVT. (And I know I'm not the only one.) For some reason, anything over about 150 tends to make me nervous. Which is silly, because I have my own PSVT issues. This reminded me of the time......

I go into PSVT about once every 2-3 months for no reason whatsoever. (I personally think that all those years on the ambulance, with the tones waking me out of a sound sleep, sending adrenaline coursing through my body, fried my AV node). I can always vagal out of it, I'm never symptomatic, and it usually only lasts for a minute or two. I only get concerned with my own PSVT if it happens more than once in a 30 day period, or if it takes me more than a minute or two to vagal out of it.

I was at work, it was about 3 o'clock in the morning (because all good stories happen in the middle of the night) and there were only 2 patients in the ER. A little old lady with a broken hip that we were holding for surgery in the morning, and a drunk who was sleeping it off in the psych bed. I was doing the pre-op EKG on the little old lady so she could get some Demerol-induced sleep, when I had that familiar Uh-Oh feeling. No, Dr. Pervert was not touching me in my no-no place. I was using more than my minutely allotment of heartbeats. About 150 more.

I finished the EKG on Mrs. We're-going-to-cut-your-leg-open-and-put-in-a-couple-of-pins-but-you're-probably-going-to-die-now-because-you're-85-years-old-with-a-broken-hip-so-call-your-family-and-say-goodbye, the whole time bearing down and hoping I wouldn't crap myself. Then I swung by the nurses' station and told Nonchalant Nurse Who Has Seen and Done Everything to come back to room 3 (where there's a crash cart) and hang out for a few.

When he got there, I was hooking myself up to the EKG machine, and I laid back and told him to capture it. It was going on 10 minutes, and I was getting a little worried. He looked at the screen, said, "Oh Shit!" , and stuck his head out the door and called Dr. Pervert.

I said, "What'd you do that for?"

NNWHSaDE: "Because your heart's beating 230 times a minute!"

ME: "No kidding, really? Is that why I'm laying here trying not to crap myself?"

The other RN and Dr. Pervert showed up at the same time, and proceeded to try to treat me like a patient. I, of course, wouldn't allow that.

So NNWHSaDE said, "Just wait for her to pass out and we'll do it. She won't last too much longer at this rate."

Other RN ran to get a barf bin of ice water for me to stick my face in, and Dr. Pervert started rubbing on my neck in an imitation of a carotid massage. I told him that if his hands got below my collar bones, I'd stab him in the eye with an 18 gauge. He laughed his creepy laugh and backed off.

NNWHSaDE was standing right next to me with an IV start kit and a couple of boxes of Adenosine. (Like the first 6 ever works.) I told him that if I went out and he let Dr. Pervert tube me, I would kill him when I woke up. (Dr. Pervert is SCARY with a laryngoscope.) He promised to bag me.

And then he said the most horrible 9 words in the English Language: "But I might let him do a rectal exam." (Dr. Pervert LOVES rectal exams.)

My sphincter tightened so fast that I'm pretty sure it sucked part of the gurney mattress in there with it.

And I converted. Normal sinus, 80 bpm.

Now, any time I go into PSVT, I just think of Dr. Pervert. It's the best vagal maneuver there is.

**In case you didn't notice, I gratuitously linked myself three times in this post. Shameless!**


John McElveen said...

Tears running down my face- LMAO so hard! Phenomenol storey! Get an Echo, Thallium and Cardiac workup- I want to keep reading you!

Your new Mom,

Uncle John

He he- Rectal she said rectal he he He he he!! And I never even watched Beaver and Butt-head! :-) Seriosly- be careful- I too had many nights of Code 3's and 83"s and ended up with a triple bypass at 51!-- first Chest pains and Nausea with diaporesis--at work!! after pushing the linen carts around from the loading doc. Poor man's stress test! LOL.

#1 Dinosaur said...


There's something called a "Beverage Alert" and it's considered polite to post one before stuff like this.

You owe me a monitor (and it's one of those nice new liquid crystal flat screens; none of those old blue bomb CRTs here, no sirree.) Covered with coffee, dammit.

Xavier Emmanuelle said...


SeaSpray said...

LOL!!! Glad I am not the only one in need of a beverage alert! :)

We had a PMD/surgeon who routinely offered pap tests to female hospital employees - even tho we weren't his patients. Uh..thanks but no thanks. Actually-just NO THANKS.