When we arrive, it has gone off four times already. I put him on the monitor.
"No wonder," I say. "It looks like v-tach" to me.
Then all of a sudden, he cries out as his whole body convulses in pain.
(The artifact was caused by the wires moving as he reacted to the jolt.)
His internal defib shocks him once more before I can get the line in and start giving him some 150 mg of Amiodarone over 10 minutes.
Here's the initial 12-Lead:
Shocking is incredibly painful. This guy, who even though he was diaphoretic, was joking with us, and then when the defibrillator went off, his whole body winced in pain, and he started cussing at me to hurry up and give him the medicine. I also gave him some Versed, and then hung an Amio drip at 30 mg/hr. He didn't get shocked again and felt much better.
His final rhythm was hard to determine. I still called the underlying rythmn v-tack. The axis was still about 215 degrees (Extreme right axis deviation). The rythmn was very funky, but his rate slowed from the 150s to 100 and he was perfusing better. It was irregular. His wife said he only had 1/3 of a functioning heart.
In the hospital his rate was down in the 80's and showed his pacemaker kicking in. They ended up admitting him.
***
I have done quite a number of these calls over the years -- it seems with increasing frequency (probably due to more people being equipped with them). Now at least we can give them Versed to sedate them a little and hopefully later forget whatever pain they feel when the thing goes off. Also I believe the amiodarone is a great improvement over the lidoicaine.
Once I did a patient who was testifying at the state capitol when he was shocked. He tried to continue, but got shocked again. (I can think of some people testifying I would love to have a button to give them a a little jolt when they tell lies).
I read once about a man who had an internal defibrillator. He was in his thirties and had several children. His defib was going off over 200 times a day. Nothing the doctors could do could get his rythmn under control. After months and months of agony, he finally asked to die. They turned his defib off and he died with his family around him.
