Friday, July 03, 2009

I've been an EKG fanatic for years. It's the topic I study the most. When I see some arrhythmia scoot by on the monitor, I want to capture it, and analyze it as if I'm Sherlock Holmes. I've never been successful in learning other spoken languages, (as my mate will attest to), but the EKG, that's a different story.


Is it SVT
Sometimes I get
Confused, and guess,
My idiot factor
Increases by doubles,
With an exponential
Rise in my troubles.

Let's examine a scenario
You've got the night-shift blues,
It's your fourth night in a row
And this one's an easy cruise,
When abruptly, you're assaulted
By alarms and lights galore,
Awakened from your reverie
You fall upon the floor.

The rhythm is wide and ugly
And it's totally bizarre,
The short trip to your patient's room
Suddenly seems quite far,
You fumble for the Lidocaine
Then stagger in the room,
Your tunnel vision activates
The flashing light, spells doom.

Is he conscious, is he dead
Is he even in the bed?
Is he watching television
Can you make a quick decision?
Should you stop a moment, and clock him
Or just go ahead and shock him?

Well, there isn't always time
To plan a course of action,
You will always get opinions
From many other factions.

Now you zap him with the macrovolts
And raise a head of steam,
He jerks up off the bed
And summons a frightful scream,
“Holy Mother of my ancestors
Deliver me from Hell,
If this is getting better
I'd rather not be well,
Because I have no recollection
No, I never have agreed,
To allow electrocution
It's just not a thing I need”.

Despite his pain and suffering
His rhythm has reversed,
He is mad as hell that you saved him
And announces, you've been cursed,
By the mother of his ancestors
The mark is on your head,
(Lord, another thing to think about
When it's time to go to bed).

Did you get a few good strips
Before you shocked that creep tonight?,
Was it SVT or TVS
Or Parkinson, Wolfe and White,
Does a delta-wave announce itself
Or remain concealed and silent,
Was it SVT aberrancy
Or something else more violent?

Is the phenomena reentry
Are the P-waves retrograde,
Does the AV-node dissociate
Or the P-waves simply fade,
Is the antegrade conduction
A sign of CMT,
Is it Atrial Fibrillation
With ventricular ectopy?

Is the axis indeterminate
Is it normal, left or right?
Is the complex wide or narrow
Or the R-wave broad or tight?
Does the QRS morphology
Have a well defined polarity?
Is it positive or negative
Are the fusion beats a rarity?
Do you notice a concordancy
In the horizontal plane?
Is there evidence of R-wave loss
Or just too-little gain?

Beware of helpful hints
That are often unreliable,
Choice of drugs is crucial
For the patient to be viable,
Like compensatory pauses
Gross appearance and the rate,
Commonly unsubstantiated
Clues of someone's fate.

The outcome, is all that matters
Did you fix it, did you not?
Could you halt decompensation
Or do you feel, your nerves are shot?
Did you conquer SVT
Or succumb to TVS,
Terrifying Ventricular Syndrome
And its' consummate distress.



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