Saturday, June 21, 2008


To preface this post, I have to say that despite our area being a teaching hospital, not all services run 24/7, and that includes the cardiac catheterization lab.

STEMI's and other MI's that come into our emerg don't automatically go up to the cath lab. Only those between 0700 and 1700 Monday-Friday. So today when we had a STEMI come in, we used TNKase.

At one point in my training I was told that TNKase can cause arrythmias. Well today, I saw it happen. The patient had stereotypical chest pain, 7/10, unrelieved by nitro. A STEMI was revealed, and TNKase initiated. Then about 20 minutes later, the patient became bradycardic, had some trouble breathing, and had worsening chest pain.

The monitor started screaming. Vtach. O shit. We scramble to get to the bedside and set up for a code. The code never happened as the patient was still awake, complaining of chest pain. The CCU doc was debating to pull out amiodarone, or whether to see if the patient would convert back. After about 5 minutes, we started seeing some regular QRS waves (with elevated ST) intermixed with the Vtach. Finally, within 20 minutes and without amiodarone the Vtach resolved completely. THAT WAS SO F'n COOL.

Sign me up for another day.

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