J is for Juice

One of the coolest things you get to do when you’re a paramedic is defibrillate. You know, like on “ER” when they grease the paddles, slam them on the patient’s chest, yell, “CLEAR” and jolt the patient off the table? Yeah, that’s really cool to do. Defibrillation is the medical term, but there are several industry lingo phrases used to describe this procedure. “Light them up” and “give them Duke Power” (our local utility) are often used, but most commonly we just say…”Juice ‘em!”

We no longer use the paddles, we now have pads that we stick on their chest and back and can activate with a button. It’s not quite as much fun, but it’s safer and gets the juice through the heart better and is more effective. Oh, and they don’t come off the table like they do on TV, they just kind of give a little jump, but it’s still really cool. This procedure is only done on someone who isn’t breathing and doesn’t have a heartbeat; so essentially, it’s done on dead people. If you can get to them when they are newly dead, it can restart the heart and they won’t be dead anymore…really cool. If they have been dead too long and it doesn’t work, well, you can’t make them any more dead so basically it’s a win/win situation.

There’s a type of defibrillation called cardioversion that’s not as much fun to perform, because it isn’t done on dead people, it’s done on people who are very much alive, and awake and looking at you as you shock the “you know what” out of them. Now, if you are faced with having to do this, then the patient is in danger of not being awake and alive much longer and your job is to “juice ‘em” at a much lower wattage and keep them from becoming dead and needing the higher wattage defibrillation…definitely not cool. We typically give them a mild IV sedative prior to this to dull the pain of having electricity coursing through their body, but let’s be real…it still hurts like hell! When it works, it kind of reboots the heart and makes it beat normally. After a successful cardioversion, you are the ultimate in post treatment cool, but leading up to and actually administering it really raises your “pucker factor”.

The scariest cardioversion I ever had to perform happened several years ago. We were called to a posh country club on a Signal 19…Heart Problems. When we arrived, we were directed to the golf course and were met by a first responder who told us that there had been an 18-hole tournament for retired cardio-thoracic surgeons. When they finished and gathered in the club house, one of the participants collapsed. We were told that he was in his 70’s, was still conscious, but looked “real bad”. When I asked if he had any medical problems, I was told that he had a history of recurrent Ventricular Tachycardia…which meant, he probably was going to need cardioversion.

My “pucker factor” went to a plus ten. Let me explain. It you are driving and come within centimeters of being hit by a semi going 87 mph, it would cause a PF+10 and you would be picking seat foam out of a certain orifice for a week. Since I wasn’t sitting down and didn’t have any material for the pucker to suck up my butthole, my PF+10 just caused my ass to invert on itself.

When I entered the clubhouse, I saw 180 distinguished looking elderly gentlemen in pastel shirts and plaid pants. Wait, my horrified memories of this event has caused me to embellish the number of heart doctors who were there; there actually were only 75…OK…30 retired cardio-thoracic surgeons watching me walk across the room with a pronounced pelvic thrust.

When I reached the patient, I found a man in his 70’s in V-Tach and he indeed looked “real bad”. His skin was the color of biscuit dough, and was very cold and clammy to the touch. His vital signs were in the toilet so I had to act fast, or he was going to get dead real quick. I told my partner to start an IV while I prepared the sedative. I voiced that I was going to give the patient 5 mg of IV Valium prior to cardioversion when I heard a weak whispering voice croak, “That’s too much”.

It had come from the patient, so not only was he conscious, he was completely oriented and wanting to participate in his treatment decisions. Now, 5 mg of Valium is a conservative dose. I could have given as much as 10, but I didn’t want to knock him out and in his present condition, that was a distinct possibility. I got close to him and whispered back, “You know what I’m getting ready to do to you, don’t you?” “Yes”, he replied, “Just give me three”. “You’re the doctor!” I answered, and drew up three milligrams of Valium in the syringe and pushed it through the IV.

We were still using the paddles back then so there was no way I could stand to the side, discreetly push a button and pretend that it was someone else attempting to shock this beloved doctor in front of all of his doctor friends. No, I had to get up close and personal while 60 trained and experienced eyes watched me as I rubbed the greased paddles together, laid them gently on his chest, called “CLEAR!” and jolted the bejeezus out of him.

“HOLY SHIT!” a loud and booming voice shouted. At first I thought it was one of the surgeons who had made the exclamation because he couldn’t believe I had just electrocuted his buddy. But, when I looked at the patient, he was rubbing his chest and cursing up a blue streak. That wasn’t the only color I saw…his skin was turning a nice pink rosy color, and when I looked at the monitor, it was loping along in a perfect rhythm. His vital signs had returned to normal and after the initial shock (so to speak) he was visibly relieved and very thankful that he had been snatched from the jaws of death.

We loaded him for transport and his former partner and best friend accompanied him to the hospital. He had no return of symptoms during transport and the doctors in the ER complimented us on a job well done and scheduled the patient for a cardiac consult. He was going to have an internal defibrillator placed that would automatically juice him whenever his V Tach returned.

His partner shook my hand and thanked me profusely for saving his friend’s life. He then asked me what my background was. “I’m a paramedic”, I answered. “No, I mean what sort of education and training have you had. You obviously know more than your typical paramedic”. I thought about trying to explain to him the advances in pre-hospital medicine since his retirement but it was clear that this guy wasn’t ever going to get it so I replied, “I had three years of medical school before I dropped out for a career in EMS”. That seemed to satisfy him. I don’t think he could have lived with the knowledge that mere ambulance drivers were performing tasks that only doctors were qualified for only a few short years ago. I didn’t care. I had dodged another bullet, and another patient was going home to his family. I went to the bathroom and threw up…all in a day’s work!