Thursday, October 9, 2008

Buy U a Drank

I had just started my shift in our critical care area the other night when, just like on a game show, the chorus of ringing alarms led me to check out what lay behind curtain number three.

My prize was a 60s-ish looking female shivering in the stretcher, with multiple liters and one banana bag hanging, whose heart was pumping away with a rate in the 180s.  I hooked the patient up to the EKG, and started running a rhythm strip as the nurse began to push adenosine.  Almost instantly, the patient started moaning, but within a few seconds her heart rate had dropped to 90 and the attending looked relieved.  

After half a minute or so, the heart rate jumped back up to 225 and her pressure dropped to 80s/70s.  While the nurse ran to prepare a diltiazem drip (a calcium channel blocker to slow the tachycardia), I went to grab the defibrillator. With the patient's pressure continuing to slowly drop, and the attending getting increasingly anxious, we just stared at this gallon-a-day drinker while waiting for the medication to be ready.  And then, all of a sudden, her heart rate spontaneously dropped down to 95, and she remained in normal sinus for the rest of the night.

Alcohol withdrawal's a bitch. 

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