What if the patient is still awake?
Don’t shock her! Don’t thump her either. Call for help, get the team to the bedside, monitor her closely because she may lose her pressure at any time at which point you can thump, or shock her. Patients in this situation are very tenuous – watch them very carefully. Usually the goal here is “chemical cardioversion” up until very recently all these maneuvers were made with lidocaine boluses and drips, followed sometimes by procainamide, but just recently I understand that amiodarone has come into the situation. Here’s my wife, also a MICU old-timer, speaking from the couch on this subject: “People still use lidocaine in this situation because that’s what they always did, so they just keep doing it, but it’s of indeterminate value.” Can you tell that she’s in grad school? “There have been no studies that show that lidocaine is really effective it’s all anecdotal.
Don’t shock her! Don’t thump her either. Call for help, get the team to the bedside, monitor her closely because she may lose her pressure at any time at which point you can thump, or shock her. Patients in this situation are very tenuous – watch them very carefully. Usually the goal here is “chemical cardioversion” up until very recently all these maneuvers were made with lidocaine boluses and drips, followed sometimes by procainamide, but just recently I understand that amiodarone has come into the situation. Here’s my wife, also a MICU old-timer, speaking from the couch on this subject: “People still use lidocaine in this situation because that’s what they always did, so they just keep doing it, but it’s of indeterminate value.” Can you tell that she’s in grad school? “There have been no studies that show that lidocaine is really effective it’s all anecdotal. There’s been one really good study out of Seattle called the ARREST study, that showed significant improvement in this
