Hit the Reset

As a nurse I have watched a lot of shows and movies and cringed and critiqued the medical aspects in them loudly, to the television screen, while everyone else in the room rolls their eyes. I want to be a consultant that helps filmmakers and book writers alike create the most accurate scenes possible so people like me don’t risk a stroke every time we watch. No, I don’t watch Grey’s Anatomy. But despite the glaring inaccuracies I did enjoy House MD.

Turns out this is what most nurses dream about. I thought I had found my niche. Oh well.

Instead of hoping to land the job of jobs as this consultant I will provide some “how it really works” education on my blog. Keep in mind some policies and methods will vary by state or even country and I am limited to the experiences I have had.

I’ve been a nurse for ten years but I have always had a medical and science based mind. Ever curious. So I knew how cardiac defibrillation worked long before ever gaining the R.N. title. What surprises and amuses me is that so many people still don’t know what those “zappy paddles” actually do.

First let me give a very brief run down of how the heart works. It uses electrical impulses to keep itself contracting in the correct sequence to best move blood around the body. If anything disrupts this sequence you could end up having a very bad day. These are the bad days that “zappy paddles” come into the picture.

Scenario: Bob’s heart has had a bad day and decided to go on hiatus. Boom. Bob’s on the ground. People see this and panic. “Bob, are you okay?” No, he’s not okay. Better cal 911.

If Bob is lucky someone has an AED and knows to go get it. These are the automated layperson friendly “zappy paddles.” They slap some stickers on Bob’s chest. It analyzes. “Shock Advised.”

Now here’s where the movies and shows go wrong. You see this chaotic scene. Someone died. They get rushed into an ER trauma bay. 16 people jump on him/her and start hooking up all kinds of things. Then... as the scene gets more tense... the paddles come out. They look at the ECG tracing. It’s flatlined. Oh no! Charge those paddles up. In a show that takes like 0.5 seconds and then ZAP!

To make the scene ultra tense the body jumps off the table, they look at the ECG tracing again. Nothing. ZAP! Again nothing. ZAP!

At this point anyone with medical training has thrown their popcorn and is yelling at the screen. “You don’t shock asystole!!”

No? Maybe that’s just me.

The reality is this: we don’t shock a heart to start it. We shock the heart to STOP it.

Let me say it one more time for those in the back. We don’t shock a heart to start it we shock a heart to STOP it.

The heart’s electrical condction system is designed very well to have its own system of redundancies to prevent screw ups but they do happen. Particularly if someone has a heart rhythm problem already, or takes certain medications, or suffers a heart attack they can be at higher risk of having the electrical system go haywire. When that happens the heart cannot work in sync with itself and doesn’t move blood through the body. The result?

You dead.

When this happens a sudden electrical discharge can be used to depolarize the whole conduction system in the heart and it stops. But, a living heart will beat on its own so after this momentary reset the impulses start firing and the heart (often times) returns to a functional rhythm.

It’s basjcally hitting a reset button on the heart. Or turning it off and back on again when it misbehaves.

But if you shock a heart that isn’t beating at all, has zero electrical impulse the electricity from that shock will not restart it. You don’t shock a dead heart. Sometimes they will try hoping there’s a little something happening they can’t see on the ECG tracing but often that doesn’t work.

And please, don’t ever play with electricity to try to stop your heart because it will probably work and I’m off duty.

Now you can throw your popcorn the next time you watch a terribly run code scene in Grey’s Anatomy. You’re welcome. :)