Tonight was absolutely great. I diagnosed a guy with rapid afib (actually the nurse did; the rate was so irregular you only had to feel the pulse for a few seconds to tell, unlike some people, where all you can tell without an EKG is that it’s fast), did the appropriate tests, moved him to a monitored floor and (with Brad’s supervision) organized enough meds to convert him back to sinus. (Which was thrilling to me; I hadn’t actually believed it possible, his rate was so high and variable.) We signed out to the day team: “Your patient went into afib with rapid ventricular response; we started him on a drip and converted his rhythm. You can consult cardiology if you want to, but he’s fixed.” (I’m sure they will put in the consult, for completeness’ sake.)

Better yet: while I was on the monitored floor watching my patient’s heart rate fluctuate wildly, the monitor techs suddenly started shouting about another patient: “What’s she doing in there? Her rate is dropping through 30!” I think literally every nurse and both aides on the floor ran in there, and found our little tiny bird of a patient huddled on the floor covered with vomit. We called a code, of course. It was the first time I’ve ever been there at the beginning, and actually it went pretty well. I started off doing the first thing I could think of, chest compressions, while everyone else was setting up suction to clear her airway. After about thirty seconds I remembered that I was supposed to be in charge, and I couldn’t think straight and do compressions at the same time, so I handed it off, and then realized that this wasn’t some random patient, it was one I was responsible for, so I actually already knew her history and her labs. Amazingly, and undoubtedly because we found her so quickly, by the time the code cart got there and got everything set up, she had a pulse again, and a viable blood pressure.

It gets better. I tried to do a femoral line and couldn’t, so Brad tried – and failed twice. He didn’t talk at all the whole time we were in there. He couldn’t very well poke fun at me, when he was being so spectacularly unsuccessful himself. I am very wickedly enjoying some schadenfreude at his expense.

And the patient is doing well in the ICU. She has a bad underlying disease, and will no doubt be dead within a few months on that account. But tonight, we saved her life.

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This is why you have to know everything about all of your patients. She had been signed out very cursorily to me. If I hadn’t gone and looked at her labs and old documentation, I wouldn’t have known anything of any value in that code. The bottom line reason for knowing everything is so that you don’t waste time when things go bad.

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