Did I almost kill someone?

luckylucyrn · Mar 24, 2007

You mean you didn't sync before the shock? That could have caused problems if the pt had been shocked on the T-wave. The patient could go into V-tach (if I remember correctly).

pfitz1079 · Mar 24, 2007

Short answer: yes

Most defibrillators that do syncronized cardioversion are designed so that the device will drop out of "sync" mode after delivering a syncronized countershock. The idea being that if a patient converts to v-tach or v-fib an unsyncronized counter shock can be delivered immediately. I always use this scenario when teaching ACLS or paramedics - it is a common error best made in training.

If you had delivered the unsyncronized shock at the wrong point in the cardiac cycle, you may have sent the patient into a more lethal rhythm. Whether or not the patient would have died as the result of your error would depend on the team's actions thereafter. Of course there's no accounting for luck, some patients respond better than others.

I'm going to be a little harsh here, but it's for your own good.

As a basic rule, one should never put into play a device, medication, or treatment modality with which one is not completely familiar. It's one thing to make this error - it's another to not understand its implications. If that was the case, you had no business pressing those paddles to that patient's chest.

The object lesson here is get the training then do the job. If you are given a task for which you have not been trained the time to speak up is not when the paddles are in your hand.

Best of luck in the future,

Pete Fitzpatrick

RN, CFRN, EMT-P

Writing from the Ninth Circle

BULLYDAWGRN, RN · Mar 24, 2007

Scary situtaion huh? I bet from now on you'll remember to hit the "sync button" when it's called for...

eric909 · Mar 24, 2007

i am curious is acls certification required where this occurred?

Medic/Nurse, BSN, RN · Mar 24, 2007

pfitz - has it RIGHT. Yep, it was a NEAR MISS.

You've been given your wake up call - NEVER FORGET IT. The difference between hero and (scape)goat is fairly narrow. You almost fell into the crack. :eek:

Not one to add too much, I'll just echo - WHY on earth were you even the one "PLAYING WITH THE ELECTRICITY"? (I only note "playing", because there is NO WAY they could have proven that you were competency assured in the task/procedure). No matter how far you are into your program, you are still a STUDENT - so I'm not sure of just how responsible you would have been held, but I will guarantee that you would have been sacrificed.

These are situations that are CRITICAL. I think you should have ONLY been in a position (in the corner) to OBSERVE.

DO NOT DO ANYTHING THAT YOU ARE NOT "QUALIFIED" TO DO.

EVER.

NEVER.

NOT ANYWHERE.

NOT ANYHOW.

PERIOD.

I, too, am not trying to be HARSH - but, if you remember this for the next 25 years and it saves you and the patient - well, it was a valuable lesson learned.

BTW, I have learned more from everything I have done wrong (or almost did wrong) than from all that went just right. :imbar Please learn from this!

Get the education. Get the experience. Get the additional training.

Become a GREAT nurse.

Good luck and PRACTICE SAFE!

TazziRN, RN · Mar 24, 2007

And keep something in mind: even once you're trained and considered proficient in a procedure/with equipment, you can still make mistakes. Do not get overconfident and complacent. Always be aware of what you're doing and go through the steps in your mind every time.

I agree with the others, though: as a student you had no business handling those paddles. No matter what your official position in the ER, no one should handle the paddles except physicians, nurses, and paramedics.

sunshines66, BSN · Mar 24, 2007

I agree with the masses, you shouldn't do something in which you do not have the proper training for. I also agree that you will never make that mistake again (not hitting the synch button). I can understand as a student that you want to soak up every bit of knowledge and experience you can. A better way would have been to watch and then later have a more experienced person show it to you more closely. I agree that you would have been the lamb that was sacrificed.

AirforceRN, RN · Mar 24, 2007

You know, its a good question...what was I doing there? As a student you want to do as much as possible. That doesn't excuse behaviour, it is just an attempt to explain it. Would I do it again? HECK NO! Did it make me sick to think about the potential? HECK YES! I had seen cardioversions many times in the past, had the run down on the lifepak was told about the pacing and the default and the potential for damage. Does that make it okay? Of course not. Yup, definitly a lesson learned, thankfully at the expense of a few nights sleep and not someones life. Pfitz and NREMT, don't worry about being "harsh", nothing you can say can make it worse.

AnnieOaklyRN, BSN, RN, EMT-P · Mar 24, 2007

You mean a syncronized shock I am assuming. 200 J seems like a lot to start off with, here in the US we usually start with 50-100.

Swtooth

AirforceRN, RN · Mar 24, 2007

Yes, it does sound like a lot. The guy had been in and out for this numerous times and from previous experience it was found that anything less than 200 would just result in the need for more shocks...

So...the moral of the story?

1) Students STAY WITHIN YOUR SCOPE OF PRACTICE, lest you do something irreversable.

2) Teachers WATCH YOUR STUDENTS, they can run amok on you and do something stupid.

eric909 · Mar 24, 2007

Well at least it turned out ok. During an ER clinical one of our students was doing compressions and without clearing the RN shocked which sent the student flying. We can laugh now but man that's dangerous.