Monday, March 16, 2009


Last week was a busy week. One of the things that made me busy was the fact the I had somewhat reluctantly given in to helping out with an elective cardioversion at work. Thursdays are usually my day off. The cardiology clinic is on Thursday and therefore the only time cardioversions are done electively. Therefore I was working on Thursday. (And therefore all my laundry caught up and passed me in the final turn for the weekend.)

Don't get me wrong - I don't mind helping out with the cardiology clinic. I usually learn a lot and think it is helpful to maintain a presence with the cardiologists that eventually make referrals for my real job of cardiac rehab nurse. I don't mind getting ready for the cardioversion itself. Don't mind getting the paperwork filled out, the consent signed, the lab run, the orders noted. Don't mind the clinical stuff of shaving the chest (if male - although I am sure they curse my name in about a week or so when all their hair starts growing back really itchy like and stuff - so I usually let Patty do that so they can curse her name) placing the defibrillator pads, starting the IV, taking the vitals, or getting the EKG to verify that they actually still are in atrial fib and really do need said cardioversion. Don't mind it a bit.

See, if a patient goes into the funky heart rhythm of either atrial fib or flutter, it's nice to get it converted back to a normal sinus rhythm. There is much debate about whether it is better to rate control (by medication)or rhythm control atrial fib- although I think the latter is preferred - otherwise why cardiovert? In atrial fib or flutter the upper part of the heart (atria) are sort of doing their own thing flopping around up there and the ventricles (lower, more powerful part) have a hard time following along and just start doing their own thing - which is good at least they are doing something - but the heart really loses a good part of its punch when the two aren't working together.

So last Thursday we wanted to get our patient back into normal sinus rhythm. The patient with advice from his physician made an informed decision to do an elective cardioversion. That is all well and good, but the part that makes me a bit nervous is having to push "the button". As the nurse helping out, I am in charge of "the button". Yep, that button. It goes something like this.

Dr. Wanner: "Are we ready?"
CRNA: "Yep." (he is sorta cocky like that)
Patient: SNORES LOUDLY- he is already under from the versed and propofol
IA Pilot Nurse: "Yes sir! Anything you say, sir!" (Nah, I usually say "yep" too - I like to pretend I am a bit more cocky than I feel)
Dr. Wanner: "Charge to 50 Joules."
IA Pilot Nurse: " Charging to 50 Joules. " (not even pretending to be cocky at this point and I select the right amount of joules on the Lifepak and charge away)
Dr. Wanner: "All clear?" (everyone scoots away from the patient - not wanted to have their own unelective cardioversion)
IA Pilot Nurse: "All Clear." (that's an affirmative)
Dr. Wanner: "...and shock."
IA Pilot Nurse presses "the button" and holds her breath.

Because what is worse than running "the button" is the one to two second pause after the shock. Any number of things go racing through my head in those one to two seconds of flatline. Really fast like this...

"where is the nearest code button, wow I really should have used the restroom before all this started, what is the ACLS algorithm for asystole again?, what is taking so long - man that pause is taking forever, is that a P wave I see - oh please let it be a P wave, speaking of P, I really do need to use the restroom, oh my, they may not be able to have an open casket funeral because I just shaved his chest, is a precordial thump good or bad these days? - I'll just let Wanner take care of that - he's got the better angle and oh please .... ahhh that was a p wave followed by a normal and lovely QRS, followed by another and another and another.

Normal sinus rhythm is a beautiful and wonderful thing after an elective cardioversion. And I'd like to say I helped - just a little.

And sort of like the A-Team of my youth... I do love it when a plan comes together.


'Captain Craig' said...

Interesting! I've heard that a precordal thump is good these days, if you're in the know. ;) Speaking of P, that reminds me that sometimes I have to P. If I really have to go and know we'll have a challenging approach, I have to take 'the walk'. The walk of shame down the aisle in front of the peeps to the lav. Remember a certain flight from Denver to Garden City, KS? ha ha No such problem these days . . .

Thanks for the fun insight into your cardioversion, IA Nurse!

Annie H. said...

Wow, I'm blown away by all your nurse nowledge. If only I could have you "sit in" on one of my English classes at the Community College, maybe you'd be similarly impressed with my skills, but then again, nah... you are da bomb. Is that how you feel when you push "the button?" Thanks for taking us inside your brain. It is very enlightening.

The B Keeper said...

Girl....I was there with ya! I can feel the apprehension of pushing the button & the dreaded pause. Brings back some very vivid memories of my own in this situation. Gosh you are a smart one & great at writing about it all ! And why is it that nurses only think about going P when they really can't !