Alarms...

Any healthcare provider will tell you about all of the "alarms" there are on all sorts of electronic monitoring equipment in the hospital.  A long time ago, a Nurse could use there judgement and turn off an alarm.  Well, obviously there was an incident... somewhere...

Now days, all alarms must be on, and at full volume!  In fact, there are some hospitals that actually disable the ability to turn off alarms.  One can silence and/or suspend for a few seconds or a minute to correct the problem, yet once the timer runs down, alarm goes off again!  This is one of the major causes of the cacophony that is experienced when a person enters an ED.  It seems like a fairly chaotic place, people moving around, talking, the incessant dinging and bonging and beeping.  The unanticipated consequence of requiring alarms to be on and at full volume... it causes people to "tune" them out.  So when an alarm is "real" it may not be responded to so quickly.

However, the solution to this has been to create certain tones.  These tones are not heard often, so when they are heard, it tends to get the attention of the healthcare provider!

~06:51am:

The Nurse I was working with and I were talking about her father coming into town next week to help her drive back home.  She is a fellow travel nurse and her contract is ending soon.  She knew that I rode.  Her dad also rides and we were talking about her renting a Harley for them and her going with him for a day ride around the Tucson area before they left.

We were sitting at the Nursing Station, she at the north desk, me at the south.  There is a Central Station Monitor on the north desk at the east end.  A CSM is basically a computer screen that displays patient's heart rhythms from a remote telemetry pack that they are wearing.  This allows us to monitor all of the patient's heart rhythms from a single point simultaneously, rather than having to go into individual patient rooms.

The CSM was to my right, her left.  The angles made it so that as we were talking, we could each see the CSM.

06:52:56am: (Start time verified by time-stamp on the rhythm strips)

Out of the corner of my eye, I saw a particular patient's "window" turn from a black background to blue... then the "ding."  The patient had had a premature ventricular contraction (PVC).  As we both turned to look, the first PVC was immediately followed by a second... then a third...

My peer said out loud, and by out loud I mean loudly, "Oh Shit!  We both jumped up and started to move towards the patient's room... there must have been a fourth and fifth consecutive PVC... as the "ding" changed to continuous "bonging!"  Sustained arrhythmia...

I yelled for the PCT to grab the 12-lead EKG machine, I turned to grab the Crash/Code cart... the sixth consecutive PVC occurred... as now the "bonging" turned into the "warble," that no Nurse ever wants to hear... the phone started to ring...

06:53:06am (Time notified verified by event-mark on rhythm strips)

As I passed the desk with the Crash Cart, I saw it was from our Central Telemetry Department, I picked up and said before they could even utter a word, "We got it."  Later I saw that I had just dropped the handset and it was laying on the counter...

My peer reaches the patient's room, flips on the lights, starts Emergency Resuscitation Procedures.  Yells at and shakes the patient to determine responsiveness... no response.  She checks for a pulse... present but weak.  She calls out her findings... there is no need for immediate CPR.

I arrive with the Crash Cart.  PCT is coming down the corridor.  My peer once again yells at and shakes the patient... this time he opened his eyes... the "warble" stopped...

06:53:23am: (End time verified by time-stamp on the rhythm strips)

After a few seconds of a blank stare, the patient gruffly said, "What!?"  He was OK.


The patient had an episode/run of ventricular tachycardia (V-tach), a life threatening heart arrhythmia that if left untreated can quickly deteriorate into ventricular fibrillation (V-fib), which again left untreated, results in death.  This is what is believed to be the cause of "Sudden Cardiac Death."

27 seconds... from start to finish... and shift change was still 17 minutes away!  No need for a morning coffee.  It would take at least an hour for the adrenalin burst to wear off...

What truly amazes me, is that the two of us were able to recognize what was occurring before the computer did, and initiate a response.  It also amazes me that the three of us were already in a full response mode, well before the other human being in Central Telemetry recognized and initiated notification.

No one will ever know if this was a paroxysmal run of V-tach, or if my peer's yelling and shaking the patient converted him.  Usually, electrical intervention (a shock) is needed to convert this arrhythmia.  Yet, down the resuscitation algorithm, the first line drug given is epinephrine... adrenalin.  Perhaps the patient had just enough perfusion to allow his brain to react to the "startle" and initiate a natural "fight or flight" response... releasing a natural adrenalin bolus.

I began to chuckle.  My peer asked me what was so funny.  I began to relate the scenario I had just seen flash in my mind...

"Patient Codes!  V-tach!  We enter the room, determine unresponsiveness and pulseless, initiate CPR, expose chest, attach defib pads... PCT enters room and hits CODE BLUE button on wall... We shock!  Patient converts... awakens... is hemodynamically stable.  Four minutes later, when the CODE Team arrives because we forgot to cancel them... we are all sitting at the Nursing Station acting nonchalantly, like nothing happened..."

We all had a good laugh at that, especially after the patient earlier in the shift that had a seizure...

 07:05am

Five minutes to shift change... so far, uneventful, final approach, coming in for a landing...

07:10am

Our relief arrives.  My new friend and I can now relax... there are others responsible now.


Two significant events in a single 12 hour shift...  I can no longer say my week has been uneventful!