What you don’t want to see. Part 2.

Here’s a query for all you EKG experts out there.

Would you call this:
a.) a sinus pause
b.) ventricular standstill
c.) asystole
d.) Oh shit! Get the code cart!

Not having seen the resumption of sinus beats at the end of this 11 second (give or take a little) “pause” the answer would have been “d”. Since said subject resumed normal sinus rhythm, albeit with a nasty left bundle branch block, “b” or “c” would be correct.

The funny thing is, the particular patient was admitted with abdominal pain. Running a 12-lead, based on age and gender, they found a new left bundle branch block. So off we go with standard NSTEMI/ACS orders. And, “Oh Shit! You said his troponin is 14…and climbing” (last I saw it was 24…) But really what are we going to do? Patient is 90+, with acute GI issues and underlying dementia: a.) Treat the GI issues? b.)Treat the MI? c.)Run around and pass responsibility?

If you work in acute care in a teaching hospital, you know the correct choice is “c”. Cardiology got mad as hell when we called, house staff wouldn’t answer the page and the attendings were not in-house yet – yes these things always seem to happen at shift change. So, we slapped pacer pads on, parked the cart outside the door and waited.

Now what happened to the patient through all of this?  He woke rather bemused to find 4 nurses staring at him from the bedside. No complaint of chest pain, no complaint of abdominal pain, in fact, no complaints at all. All he said was, “Boy, I sure do feel better seeing all of you come around to take care of an old guy like this. You sure do know what you’re doin’.” Only thing was it woke him out of a dead sleep…

Figured it wouldn’t be a good thing to tell him he was actually dead for 11 seconds, might be to much to bear. Besides, he had nothing but confidence in us, and we wouldn’t want to shake that!

edit…had to compress the length of the strip so that it wouldn’t run off the edge of rss readers and the site itself.  Click on it for all of it’s glory.