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What's the weirdest cardiac rhythm you've seen in the PACU?

Posted

Specializes in PACU, presurgical testing. Has 4 years experience.

I recently heard someone at my institution say that nothing interesting happens cardiac-wise in the PACU. Right. I haven't even been there that long but already knew enough to protest! That very week I had cared for a child in trigeminy PVCs; I have also seen people in SVT from cocaine used in intranasal surgery, had an AICD fire after a few runs of V-tach, and even had a patient this week in sustained V-tach who was talking, looking around, and generally doing A-OK. We've also had codes for asystole and PEA, and I think some weeks half our patients are in nasty Afib. What's the weirdest cardiac rhythm you have seen in the PACU?

sbfairy

Specializes in PACU.

Accelerated junctional rhythm. Not too exciting

Really Really Wide QRS. and thats about it. I mean obviously I've seen other things but they are usually short lived. I'd agree with what the one person said about cardiac issues in PACU. I haven't had to code someone in PACU in 4 years. The other morning the person was completely blue,septic,and near death and he still had a pulse and a fairly sinus rythym ( side note after I post this I'm sure I'll be doing CPR)

I had a young dialysis patient (lap chole) who would invert his T waves when his mean BP droped below 100.

Been there,done that, ASN, RN

Has 33 years experience.

Junctional rhythm in the 40's .. with ventricular escape beats kicking in to " pick up the pace".

Very strange on paper. However, the patient was asymptomatic.

The conduction system is a work of art.. that we are better left to observe, rather than interfere with.

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

This wasn't in PACU, but in the ICU shortly after coming out of the PACU. I don't remember what her admitting dx was, but she had gone to the OR for a massive arterial clot in her leg...I do remember she was NOT a cardiac pt.

Anyway, she would flip between VT, asystole, SVT, SB in the 30s, and NSR. She'd be in each for a few seconds at least. She was fully conscious the whole time, responded w/ a weak "I'm fine." We gave calcium gluconate, KCl, MgSO4 and possibly NaHCO3 also (can't remember), and we had the crash cart in her room...beyond that myself, 2 other RNs and the SICU resident were in there just staring at the monitor, watching her BP tank and come back up depending on the rhythm, and asking her "You still with us?" She wouldn't stay in any one arrhythmia long enough to treat it, plus the they were so different. I mean, we don't treat VT and asystole the same, right? lol The resident said to me, "You didn't think you were going to be a cardiac nurse tonight did you?" I said, "Actually I did used to work in a CVICU, but I've never seen someone do this." :)

This lasted maybe half an hour, and then she converted back to NSR.

Christy1019, ASN, RN

Specializes in Emergency/Trauma/Critical Care Nursing. Has 11 years experience.

This wasn't in PACU, but in the ICU shortly after coming out of the PACU. I don't remember what her admitting dx was, but she had gone to the OR for a massive arterial clot in her leg...I do remember she was NOT a cardiac pt.

Anyway, she would flip between VT, asystole, SVT, SB in the 30s, and NSR. She'd be in each for a few seconds at least. She was fully conscious the whole time, responded w/ a weak "I'm fine." We gave calcium gluconate, KCl, MgSO4 and possibly NaHCO3 also (can't remember), and we had the crash cart in her room...beyond that myself, 2 other RNs and the SICU resident were in there just staring at the monitor, watching her BP tank and come back up depending on the rhythm, and asking her "You still with us?" She wouldn't stay in any one arrhythmia long enough to treat it, plus the they were so different. I mean, we don't treat VT and asystole the same, right? lol The resident said to me, "You didn't think you were going to be a cardiac nurse tonight did you?" I said, "Actually I did used to work in a CVICU, but I've never seen someone do this." :)

This lasted maybe half an hour, and then she converted back to NSR.

Did you ever figure out the cause of this??

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

Did you ever figure out the cause of this??

We didn't figure it out that night. She went to stepdown the next day, so I'm not sure what happened after

Sinus brady low 20's. Pt was awake and talking.