Unfortunately we only had 1, yes 1, critically ill patient this weekend. Words cannot describe the letdown of complete boredom when this said patient slept the entire shift, except for a few moments of waking and talking to her family. It was the longest 8 hours ever. Well, almost ever. At least I didn't have to squirt any saline into my eyes to keep them from shriveling up from dryness :)
90 y/o comes into the ER from the nursing home with bradycardia. Turns out the potassium is 8.2 and is also in acute renal failure. Rhythm is oh so regular after atropine... 3 nsr beats and then a nice long sinus arrest pause. And it stayed this way for awhile until turning to sinus brady, rate of 40-50. Wonderfully spiked T waves. Emergency dialysis was scheduled, and a catherter inserted into the femoral vein. 15 minutes into dialysis... those T waves came right on down and NSR emerged with a rate of 70s-80s. Amazing, really.
This was the night before. Now, as my night moved along at the speed of a snail... I continuted to watch the rhythm, if not for a lack of better things to do. Potassium was now 2.3 and some ST depression was evident on the ECG monitoring. Some PACs were thrown in now and again, coming at faster intervals as time moved along. About 6 am...the rhythm went to 2:1 flutter for about 30 seconds and right into AFib. Have to say, that was about as interesting as the night got. Can't say that I have ever seen someone convert to AFib, so got to see something new. I wonder though.. did it stay in AFib or was it just transient?
I don't know where this patient progressed from there... I left at 7 am and didn't have to return until next Friday night. Chances are that this patient will no longer be a resident in the ICU, but moved out to the floor or even back to the nursing home by that time. Perhaps next weekend will be more interesting. Although I have to say that after this last week of clinicals.. it was nice to have an easy night of work.
One last bit of information told to me by the charge nurse: If you have to ask if you should call the doctor, then you probably should.
have a terrific monday! :)
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