Eerie

I walked into a new patients room at 0800 to give him his first duoneb
of the day. He was not looking so good. He was sitting on the edge of
the bed, tripoding and pursed lip breathing. He hand were shaking real
bad so it was hard to get an accurate spo2. I also noticed that he had
some cankles going on. Instantly I think CHF. He looks a little dusky
so I take off his cannula and start up his treatment. His color
improves, his shaking subsides...generally looks a little better. Then
he tells me...

"I don't think I'm gonna make it today."

I reassure him and tell him that as soon as we get the fluid off of
him, he will feel better. My treatment is over, his vitals are stable,
so I tell him I'll see him in a few hours and leave.

Rapid response team to room 173. Rapid response
team to room 173. Rapid response team to room 173.

Shit!!! It's 0830. I just finished up his last treatment. Shit!!!

We walk in his room & he looks exactly the way he did when I first
walked in the room. He proceedes to tell us that he hasn't taken his
lasix in 7 days. Dr W happened to be around so he is there with us and
orders 80 of lasix. I slapped on another treatment just so everyone
will feel better, he gets his lasix, then I leave as they want to
start a foley.

Code blue room 173. Code blue room 173. Code
blue room 173.

Shit! Damn it! I looked at the clock. It's 1030.

We get in his room and start CPR. He is in PEA so I am doing
compressions, telling the er doc that he told me he wasn't going to
make it. He is intubate and I switch with the student. I see a rate
on the monitor, but of course, its just us. Someone brings in a
Doppler. Still no pulse. I resume compressions, look at the monitor
and am pleased with my efforts. Looks like vtach with a rate of 105.
Pretty effective. As I'm mentally patting myself on the
back...

Oooowwwwccccchhhhh!!!!

In the split second to took my hands off his chest, I saw his limbs fly up and realized his internal pacer/defibrilator had fired.

Ah damn, that hurt.

After 30 minutes if ACLS, the code was called.

Two things I learned from this...

1 - when a patient tells you he's gonna die...even if you don't think
so...pay attention.

2 - beware of those pesky implanted defibrilators. Everyone but you
will think its funny when you get shocked.

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