Cardiology - PGY-1

it's 2 a.m.

I am up at 2 a.m., and it's not good. It's not the cozy, comfy slumber under weighted blankets, head resting on a buckwheat pillow with no one snoring beside me.

No - I am up in greens, standing in sweaty socks and work shoes that were put on at 7:30 a.m. the previous morning. Staring at a screen that looks like a three-year-old's etch-a-sketch.

SECURE THE AIRWAY!

The Pusher in my head screams at me.

"Goddammit -THINK! Remember what to do!"

But I can't.

I can't think.

Until the adrenaline kicks in and surges through my brain, on a mad search for clues.

Where did I read this? I flip through the rolodex in my head, filled with memories of yellow highlighted text-book passages. The important things. The things you need to know, or else someone could die.

Passages repeated in my mind at least three times to commit them to memory for THIS exact moment, at 2 a.m.

And It's 2 a.m., and I can't think.

Wait! Wait!

The card is in my pocket.

I flip it open, turn it over, right side up, and try to focus on the too-small print of the algorithm for Ventricular Fibrillation. (V-Fib, for short, because there is no time to pronounce the whole name).

Then I command:

EPINEPHRINE 1 mg IV PUSH STAT!

No change.

AMIODARONE 300 MG IV PUSH STAT!

No change.

GET THE PADDLES READY!

Paddles on.

All clear? ALL CLEAR!

Shock – no change

Turn it up.

All clear? ALL CLEAR!

Shock – No change, again.

One more time.

I watch the screen to see if the electrical current returns to a normal rhythm because I think, as we all think, this will make a difference.

Like on TV.

FIGURE 1. Ventricular flutter and ventricular fibrillation. (A) The sine wave appearance of the complexes occurring at a rate of 300 beats per minute is characteristic of ventricular flutter. (B) The irregular undulating baseline typifies ventricular fibrillation.

Source: https://www.sciencedirect.com/topics/medicine-and-dentistry/ventricular-fibrillation