If someone's heart slows down and won't speed back up we are required to fix that. Our first line treatment is a drug called atropine. Atropine decreases vagal tone, more or less taking the body's brakes away. It's not a gas pedal like epinephrine, it just takes away the feed and breed functions so to speak. If that doesn't work and the patient is symptomatic, chest pain, shortness of breath, dizziness, low blood pressure, then we have to correct this. The way we do that is by using our handy dandy heart monitor to send a small jolt of electricity through their heart 70 times a minute. Essentially we take over the heart beat, which is too slow, and tell it to beat faster with this 70 beat per minute shock therapy. So the patient sits there going. "Ow, ow, ow, ow ,ow." Every time it fires. I imagine this hurts but we give them versed to make them forget and morphine to make them comfortable. You can see their whole chest, and even neck, contracting with each little shock.
We get a page for an intrafacility transport. The city ICU to an ICU about 50 minutes away. Cardiac patient getting paced. We got there, got report, moved the patient to my machines and I took over his pacing. The patient was concious but heavily medicated and the pacer was set extraordinarily high. The doc said it was the only way they could get capture. So we loaded up and head to the big city hospital with the lights and sirens on. The trip was completely uneventful. The patient did fine and the roads were clear.
We got to the hospital ICU and met the patient's new nurse. I have to say, right from the start we did not hit it off. She was griping about this nurse and that nurse, and the secretary wasn't doing her job, she had to come off break to come get this patient, why are we here early, and on and on and on. Whatever. I don't get paid to care about her problems, only about my patient's problems. I shake my head and she jumps down my throat, "Why aren't you moving him, get him moved over now!" Really? My partner, the patient, and I all make eye contact. I kind of felt bad for the patient now.
Of course she doesn't lift a finger to help us. As she rifles through the paperwork we transfer the patient to the new bed and start moving equipment. All of the sudden she's in my face again. "Why don't you have the right paperwork!?! You are supposed to be health care professionals, you should know what paperwork you need!" Now I'm getting pissed. I asked her what she was looking for and she told me. I showed her where it was, she just missed it. Instead of being grateful she gripes some more and indicates it was my fault she missed it.
I kind of snapped and told her to get her monitor ready, we need to transfer pacing to her machine.
She looked at her monitor and the at my pads and chicken little the sky is falling! We had different machines and the pads were not interchangeable. All it means is that we would have to shut off the pacer for a minute while changing to her machine. While that can be dangerous to a patient being paced, if we timed it right it is not too big of a deal. She's now speaking acid at me. Throwing paperwork down and medical paraphernalia around. I am the devil according to her. All that's wrong in this world is my fault. I should have had the foresight to know that her machine wouldn't match mine and force my company to buy the right kind of heart monitors just prior to this transport. You may think I am embellishing here but I assure you I am not. This woman was possibly the meanest person I had ever met and she was pissed at me. The patient is now looking rather alarmed and is throwing looks my way suggesting I take him to another hospital and my partner is standing in the corner steaming.
The nurse looked at me and said "WELL!! What are you waiting for?" With that she stomped over to the patient and ripped both pacer pads off his chest violently, pulling two big patches of chest hair off the poor man. Wait! It's still on! I promise I tried to warn her but she was moving too quickly. Both pacer pads slapped together on her right hand, one on top, one on bottom. And those things are sticky. She suddenly yelped and convulsed, followed immediately by another yelp, and another. Then she screamed and began shaking her hand in front of her, rapidly hopping across the room in a very animated imitation of a rabbit on speed. She got faster and faster and louder and louder. We were stunned. Speechless. Frozen. Am I really seeing this?
After a few moments of her spasmodic break dance across the room I reached over and turned the pacer off. The nurse doubled over gasping for breath, ripped the pads off and ran from the room. The patient giggled. Then my partner giggled. I could feel the twitch of a smile and couldn't help myself. We started laughing, and laughing and then laughing some more. We were in there braying, honking snorting, eyes watering and falling over. Couldn't have happened to a better person.
I then remember the patient's not getting paced so I looked at the monitor and his heart rate was normal. I checked his pressure and that was good too. Huh. Looks like she fixed him. His color was better and he was in good humor now. A few minutes later a different nurse came in and introduced herself as the patient's new nurse and we never saw the other one again.