About a year ago, I had the most memorable night of my internal medicine residency--and probably the most memorable night of my entire life.
I was nearing the end of my day in the Intensive Care Unit (ICU). Just before evening sign-out, one of the patients started to decompensate, aka get very sick very quickly. For the next several hours time stood still, and I remember every second like it was yesterday.
It Started with a Heart Rate Spike…
The elevated heart rate was consistent with a rhythm that we call atrial fibrillation, and sometimes this fast heart rate can cause blood pressure to drop (as there is not enough time for the heart to adequately fill to eject enough blood to support the body). Fortunately, the rate spontaneously normalized, but only transiently. Soon the monitor showed rates into the 200s and blood pressure was rapidly dropping.
We “shocked” the patient (synchronized cardioversion) to try to break the abnormal rhythm, to no avail. He then lost pulses and the rhythm was no longer shockable, therefore chest compressions were initiated. After two rounds of CPR and pushing epinephrine, we got him back.
The room was calm. The teamwork was flawless. Everyone was performing their tasks swiftly, and without hesitation. Things were stable, but we were not out of the woods. It was unclear what led to this acute change.