Subaqua Sternal Rubs

Well, I wasn't expecting to put up another EKG so soon, and I know I promised not to write any more before I left, but this was an interesting case from this morning.

I was working the Triage Desk at the Emergency Department on the overnight shift. A 54 year old gentleman presented with palpations (feels like heart is pounding), chest tightness, and severe diaphoresis (sweating). The only history that I could get out of him was that he had problems with his heart ryhthm before, but he couldn't remember his diagnosis. He was supposed to be taking some medication for it, but he couldn't remember, and he had stopped taking it the week before anyways. He had been to a cardiologist, be he couldn't remember his name either.

After getting a quick set of vital signs, I get him into a wheelchair, bring him back to an examining room and place the EKG leads on. This is what I get:

(Click for a larger image)

My first thought was that "that doesn't look good." Next thought: "That looks like SVT" (Supraventricular Tachycardia) The monitor is reading that the pulse rate is 212. (60-100 is normal) I run out to go grab a nurse, and the only one I see is in another room with another patient. As the other patient looks stable, I impress upon her that she should go take a look at the new patient in room 9. She finishes what she is doing, and by the time that she is in the room, the patient's ryhthm has spontaneously broken to atrial fibrillation, at a rate of 120. (This ryhthm, while not normal, is quite common, and many people walk around with it daily.)

Needless to say, I looked like a fool…. Why couln't he have stayed in the more life threating condition, well at least until the nurse got there… That way she wouldn't think I was crazy… Oh well, I am just kidding, I am glad that this patient's life-threatening condition resolved on its own, without the need for anybody to do anything.

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