Asystole "observed" for 25 seconds?

  1. 0 The other day, I came across a tilt table test on a patient. It was a young person who had been experiencing syncopal episodes and so was sent for the study. I was amazed to come across the phrase "patient lost consciousness and asystole was observed for 25 seconds, after which a regular bradycardic rhythmn returned."

    Observed?:uhoh21: For twenty-five seconds?

    I was floored and wondered if I was missing something. It could not have been a mis-transcribed word, because asystole was mentioned 2 more times and the context was correct all 3 times. I asked an anesthesiologist and he was as surprised as I, but was busy at the time and simply laughed and said "well, that was a long 25 seconds!"

    The test did not have any relevance to the patient's care in my facility and in fact was historical so I didn't even bring it to anyone's attention. It had obviously been reviewed and had not raised any alarms with anyone (including the cardiologist who treated the patient at the time).

    What am I missing? Is it normal (a) to experience asystole in a tilt table test, and (b) for the asystole to simply be "observed"?
  2. Visit  roser13 profile page

    About roser13

    roser13 has '17' year(s) of experience and specializes in 'Med/Surg, Ortho, ASC'. From 'Midwest'; 58 Years Old; Joined Feb '09; Posts: 4,121; Likes: 11,980.

    14 Comments so far...

  3. Visit  jrodrig2 profile page
    0
    adenosine? good thing that node kicked in. any EP nurses explain that one?
  4. Visit  casi profile page
    0
    I've observed asystole for that long.... as I went running for the crash cart. But I have seen patients have asystole or pauses for that amount of time.

    Don't really know anything about the tilt table test however.
  5. Visit  Jenni811 profile page
    0
    were they given adenosine?? I would probably flip if i saw asystole for 25 seconds. Even if it was followed by bradycardia. I really don't know too much about the tilt table. but i can't imagine that would cause asystole.
  6. Visit  ScottE profile page
    0
    Asystole is never normal, well unless the person is dead. It's probably some really really weird vasovagal response, but . . .
  7. Visit  suanna profile page
    2
    30 seconds dead is a long time in my book. If you ever saw that on my chart-let me know- I would want someone to be looking at pacemaker placement. I'm thinking half a minute dead would be a good reason for the syncopy. The only thing I can guess is the patient was on some medication for HTN- a beta blocker or combo med- or on an anti-arrythmic amiodarone?, that the cardiologist stopped after the patients brief look at the other side. Is it possible the patient has a renal hx and had a high potassium at the time. I've worked cardiac my entire career and I don't know any doctor that wouldn't be anxious about a 30sec pause.
    Otessa and diva rn like this.
  8. Visit  scoochy profile page
    0
    Was the patient being worked up for dysautonomia?
  9. Visit  AntFlip7395 profile page
    1
    It is not uncommon to observe asystole during a tilt table test. Since this was a young person, they were likely referred to the cardiologist to be worked up for neurogenic syncope. Sounds like it was a positive result!
    Otessa likes this.
  10. Visit  mama_d profile page
    1
    I have a friend who is dx with POTS. During her tilt table test, she went junctional @ 40, then brady in 20's, then passed out...apparently when she passed out she had an approximately 15 second pause, which earned her some adenosine.

    Which led to a debate on my floor...when does it stop being a pause and start being an episode of asystole?
    Otessa likes this.
  11. Visit  hherrn profile page
    0
    Quote from mama_d
    i have a friend who is dx with pots. during her tilt table test, she went junctional @ 40, then brady in 20's, then passed out...apparently when she passed out she had an approximately 15 second pause, which earned her some adenosine.

    which led to a debate on my floor...when does it stop being a pause and start being an episode of asystole?

    atropine?
  12. Visit  diva rn profile page
    0
    This sort of reminds me of the time I found my exhusband on the floor...in asystole...well, without a pulse and respirations anyway...called 911 and started CPR and he actually regained conciousness as they got there.
    After an extensive workup, the cardiologist thought he had some kind of funky vaso-vagal thing but not real sure. If he did it again, they were going to pace him. Don't know how long he was down, but he was pretty dusky and cyanotic around the lips...happened around 28 years ago...and haven't thought about it for such a long time.

    By the way...I wasn't a nurse yet back then and he is no longer my husband (but not because I didn't know CPR)

    ps. not adenosine....atropine?
  13. Visit  Do-over profile page
    0
    Yeah, I am thinking they meant atropine, not adenocard.
  14. Visit  roser13 profile page
    0
    Quote from scoochy
    Was the patient being worked up for dysautonomia?
    She was being worked up for syncopal episodes. No treatment given that I could find documented, just the "observation."

    Eventual diagnosis from cardiologist, according to patient: vasovagal syncopy, expected to be outgrown (patient was teen at the time).


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