Age Hysteresis in Thump Cardioversion
Report:
Sinus tachycardia 120/min
Ventricular tachycardia, polymorphous, non-sustained, 258/min (top) & variable rate
SVEB
Thump artefact (marked)
Comment:
The demonstration was deemed quite successful, until the monitor recording came out in print. The “cardioversion” was only convincing before the paper record.
The exact age of the Intensivist is less important than the fact that he was becoming a little sluggish. The thump was effected in the expectation of longer, more sustained run of VT. As with carotid massage or passage of a Swan-Ganz catheter, the thump requires an eye on the monitor rather than the patient at the time of the procedure.
Thump (fist) cardioversion can cause more harm than temporary embarrassment: acceleration of VT or change in its morphology, or even VF. It has its supporters68, but is not a standard procedure69.
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