PakMediNet Discussion Forum : Medicine : Reperfusion Arrhythmias after SK and 75 DC Shocks
Reperfusion Arrhythmias after SK and 75 DC Shocks
Last week we have received a patient having typical history of left sided chest pain along with sweating and apprehension. His ECG showed acute anterior wall MI. Therefore, thrombolytic therapy was planned. He was given 1.5mU of Streptokinase (SK) within 1 hour of arrival. After 1/2 hour of SK infusion, he developed VF. Immediate DC shock of 200J was given and patient regained sinus rhythm. Within next 5 minutes, he again developed VF and again was reverted back with DC Shock. After that, he was given IV bolus of Lignocaine and then maintainance infusion at 2mg/kg.
However, after 10 minutes, he again developed VTach and VF. This tried of VT and VF kept on went for next 5-6 hours and he was given 75 DC Shocks (360J) for that.
We have never encountered such strange type of reperfusion arrythmias ever in our life. I think this is a record that he received 75 DC shocks. After that, he was shifted to CCU and kept under intensive monitoring. He never developed any sort of arrythmias again and dischared in stable condition after 5 days of smooth recovery.
Users are requested to give their comments!
Posted by: docosama Posts: 333 :: 15-08-2002 :: | Reply to this Message
Re: Reperfusion Arrhythmias after SK and 75 DC Shocks
Very interesting. I hope that all those episodes were real and not some problem with the monitor or the leads. LOL
I'm sure for one thing' that all those shocks cured his depression.
[Edited by chameed on 08-26-2002 at 10:31 AM GMT]
Posted by: chameed Posts: 173 :: 26-08-2002 :: | Reply to this Message
Re: Reperfusion Arrhythmias after SK and 75 DC Shocks
I do not find this episode funny at all. Just this morning we received a patient in our ICU at ISIC-Escorts Heart Command Centre New Delhi. The patient is a known hypertensive and a follow up case of COPD. He had a history of fever for last one week with a high grade fever (104 F) last night. He was brought to the hospital in a state of altered sensorium .Patient was hemodynamically stable but owing to his poor neurological status GCS-6 and a compromised airway he was put on mechanical ventilation. Suddenly the patient went into VF and had to be cardioverted with 200J following which he reverted to NSR. Subsequently he had episodes of VF every five to 10 minutes and had to be cardioverted repeatedly (28 times in fact till now). Presently the patient is on iv amiodarone,phenytoin, xylocaine and magnesium sulfate.Echo and baseline ECGs have all been normal. As the patient has leukocytosis he has also been put on iv antibiotics. However we haven't been able to shift him to the CT scanner room till now owing to his unstable condition. He has improved neurologically GCS-14.So i guess there is no limit to human endurance and there is nothing to laugh out loud...
[Edited by docosama on 02-25-2003 at 03:11 AM GMT]
Posted by: ritwik21 Posts: 2 :: 25-02-2003 :: | Reply to this Message
Re: Reperfusion Arrhythmias after SK and 75 DC Shocks
Instead of memorizing books written by your British/American masters, you should use some common sense, come up with something original and apply it your own population. I cannot go into any details as to why so many DC shocks were required, but I can say this that DC shocks do not work until all the electrolyte channels at the cellular level are in functioning order. What you said is laughable and is nothing more that dogma of ignorance, so no need to feel so insecure, continue your persuit and one day your feeble mind might click. Have a good LOL.
[Edited by chameed on 03-17-2003 at 06:51 AM GMT]
Posted by: chameed Posts: 173 :: 17-03-2003 :: | Reply to this Message
Re: Reperfusion Arrhythmias after SK and 75 DC ShocksWell when you are in practical situation, and patient develops VF in front of you, instead of thinking about Electrolyte changes as a cause, your first job is apply DC shocks to that patient to revert it back. Once it is back, then get the electrolytes. I dont know any Lab who can offer electrolyte results within seconds. This process takes atleast 1-2 hours and if patient develops VF again during this time, should we wait for electrolyte reports or cardiovert him again ?
Posted by: docosama Posts: 333 :: 18-03-2003 :: | Reply to this Message
Re: Re: Reperfusion Arrhythmias after SK and 75 DC Shockswell a real case in life.Books are there for reviews but one should think to
Posted by: Alamchik Posts: 4 :: 13-10-2003 :: | Reply to this Message
Re: Reperfusion Arrhythmias after SK and 75 DC Shocks
interesting case. Ill request individuals to make constructive criticism to improve all of our knowledge and skills.
Good for this patients physicians and the patient himself since the outcome was good.
One consideration in such hemodynamically unstable patient could have been intubation and adequate sedation while he needed all these shocks.
A loading dose of amiodarone and the a 24hr infusion per protocol could have stabalized his membranes and prevented the need for repeated shocks. Lidocaine is not the medication of choice here but i understand that there may be a lack of availability issue.
Posted by: icumicuccu Posts: 16 :: 12-05-2004 :: | Reply to this Message