He started out like most other patients admitted to the hospital. An active smoker with active shortness of breath came for acute exacerbation of his chronic underlying progressive multiorgan disease, The admitting diagnosis was the internist trifecta: COPD exacerbation, CHF exacerbation and pneumonia. Of course, there are some patients in whom you just can't tell. Their heart, their kidneys and their lungs prevent an accurate diagnosis. So you put them on steroids for their COPD and hope their CHF doesn't get worse. You put them on diuretics for their CHF and you hope their kidneys don't get worse. You give them antibiotics for their pneumonia, because, well, everyone in the hospital deserves a course of antibiotics. That's why we have hospitals.
But what happens when the trifecta is complicated by something like cardiopulmonary arrest?
Atrial fibrillation plus severe respiratory acidosis
Became PEA
Became VF
Became sinus with 360 joules of electricity
And eventually a narrow complex sinus rhythm on the road to complete neuro-cardio recovery.
This was cardioversion of atrial fibrillation: The Wild Unsynchronized version. Now if I could only make his heart, lungs and kidneys survive without chronic anaerobic metabolism, he may just have a few years left in him.
I bet in the next thirty years I will never have another patient present with chronic atrial fibrillation converted to sinus rhythm through ventricular fibrillation. I think the AHA should amend their ACLS protocols to include Happy's new arm of resuscitation: The unsynchronized cardioversion of atrial fibrillation.
365 Days Of Discharge: Episode 3
365 Days Of Discharge: Episode 3
