Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Cardioversion – 2010 ACLS – Part III

 

Continued from Cardioversion – 2010 ACLS – Part I and Cardioversion – 2010 ACLS – Part II.

I finished off Part II with –
 

In what way is the electrocution cardioversion or defibrillation of an awake patient not a sentinel event that needs to be discussed with the medical director?
 

Maybe I should have written –
 

In what way is the electrocution cardioversion or defibrillation of an awake patient not a sentinel event that requires the medical director to justify the abuse of this patient to the state medical board?
 

Here is a comment posted to my original post on cardioversion –
 

I’m an individual who was cardioverted while awake – during transport by yellow ambulance I had a pulse was breathing and a rapid heartbeat, I begged the worker not to shock me. It was a hell I never want to experience again. My eyes saw silver then black my ears popped and started ringing, I started convulsing, my face dropped on the right for two days. Its been a year. I suffer from severe tinnitus, falling, headaches, hearing loss, facial numbness loss of sensation in my fingertips on the right…DONT EVER SHOCK SOMEONE WHILE THEY ARE AWAKE. Get this – a doc from a hospital I wasn’t being transported to gave the order at 70 joules…my life is forever changed.[1]

 

The symptoms do match those for electrocution/lightning strike.

Would things have been different if she were sedated?

Her memory of electrocution would not be there, or it would not be as dramatic.

This was apparently only a single shock at 70 joules.
 

How about a well documented case from one of the top cardiologists in the world?
 

The man’s very first utterance was, “If it happens again, just let me die.”

As I discovered, the reason for this patient’s terror was that he had been cardioverted in an awake state. Ventricular tachycardia had been relatively slow, he had not lost consciousness, and the physicians, in the heat of the moment, had not administered adequate anesthesia. Although the 5 mg of intravenous diazepam had made him a bit drowsy, he felt the electric current on his chest and remembered the event clearly.

The patient’s mental state complicated the case considerably.[2]

 

“If it happens again, just let me die.”
 

This patient is not complaining about his medical condition.

This patient is complaining about the complete abdication of the doctor’s responsibility to the patient complete lack of sedation for cardioversion.

How bad does our treatment have to be for patients to prefer death to treatment?

How irresponsible is it for medical directors to not prepare us for this?

Footnotes:

[1] Cardioversion – I’m not doing that, you do it!
Rogue Medic
Article

[2] The calamity of cardioversion of conscious patients.
Kowey PR.
Am J Cardiol. 1988 May 1;61(13):1106-7. No abstract available.
PMID: 3364364 [PubMed – indexed for MEDLINE]

.

Comments

  1. Adenosine for conscious, alert, mildly symptomatic pt. VERSED for electrical cardoversion, plz. A crap ton of versed…

  2. So, I’ve witnessed someone get cardioverted once a long time ago. Have all your arguments about unstable vs stable. Do it once, have them get cardioverted with ABSOLUTELY no medication and then the next words out of their mouth are coherent, but along the lines of “what the @$%! did you do to me?” or “why the #$@! did you do that?” and tell me that’s not torture. Thankfully I think a fair number of systems have gotten to the point that they allow you to medicate, but still too many that say that there’s not enough time to do so because if we don’t, “they might die”. I highly doubt that, and if that’s the case, well, cardioversion probably won’t work fast enough anyway. Thoughts? Interested to hear your further thoughts oh great rogue one.

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