Adenosine

I have taken a long hiatus from posting on this blog.  I have had many an exciting nights, including one patient with a mental history that bit a nurse on the arm, a Security Code was called and we had to restrain her.  That got my blood flowing that night. 

But for the most part, my nights are pretty routine.  Except for last night.  I was taking care of 3 patients, when the charge nurse approached me and said that I had a new admit and they were already in the room.  Typically there is about an hour notice until the patient is admitted.  So this was quite a surprise.  If found out that she was in our transitional care center and her heart rhythm changed to SVT (Supra Ventricular Tachycardia).  Her pulse was in the 170's, but totally asymptomatic.  The cardiologoist had me start a large bore IV on her to get her ready for the medication he was going to push.

We had the ECG machine all hooked up to her to monitor her rhythm continuously.  The cardiologist pushed 12mg of Adenosine.  Adenosine is a cardiac drug that blocks the AV node in the heart and it basically resets the heart to a normal sinus rhythm.  I had never seen it pushed before but heard stories.  He pushed Adenosine and we watched her and the monitor.  All of a sudden she sat up and was very disoriented and thought she was going to die.  At that moment, I watched the monitor and her heart paused for a good 15 seconds, with a few beats that escaped from other parts of the heart. Not having a heart beat after her heart rate was in the 170's was a HUGE change.  So basically the Adenosine stopped her heart and reset it.  Then all of a sudden, her heart beat became normal sinus rhythm in the 80's.  It was exciting to be there.  I spoke the the Cardiologist and we had a lengthy discussion on her case and then I told him, next time, I want to push the Adenosine. 

Thirty minutes later, we sent her back and life on the tele floor went back to normal.  I hope I get more chances like that in the future.