TSH: I got to do ECT!

This morning all five of us went to the ECT treatment rooms (former operating rooms within TSH) to meet Dr. P and Dr. C for patients needing ECT treatments. As luck would have it, four patients needed ECT, so Dr. C let each of us do ECT on one patient. The process is not too complicated. The patient lies down and is offered a blanket while electrodes are placed to the forehead, the mastoid processes, and the clavicle (ground). A blood pressure cuff is tightened around one leg. The patient receives succinylcholine to relax the muscles and other anesthetics to knock them out. A bite piece is placed in the person's mouth so s/he won't bite off his/her tongue. Once the EKG is up and running, the med student places two electrodes (with the ends gelled) against the patient's head. The location is between the ears and the eyes, then up one inch in a shallow indentation of the head. We press a button on one electrode, there are three warning beeps, and the shock is administered through the electrodes into the patient. After eight seconds pass, the shock stops and we release the button, and we watch the patient to make sure s/he has at least 20 seconds of seizure activity. If not, the treatment is unsuccessful and you have to do it again. (Seizure activity is monitored on the EKG)

ECT sounds horrible, but it's really a harmless procedure. The patients are asleep during the whole thing, and because they are given succinylcholine, their bodies don't move during the shock except below the blood pressure cuff on one foot (since no drug was able to get there); even then, the foot just shakes a little. When I felt the shock go into my patient, I felt her stiffen, and to my surprise, her entire body started shaking, just a little. A note for the next treatment: increase succinylcholine. Pretty cool stuff =)

After we had lecture with Dr. C (again), the others all went home while I went to Dr. R's unit to play my violin for its patients (I'd told her before she left for vacation that I'd do it) I sat down on a table and took requests from patients, and when they had nothing to request I just chose a few songs of my own to play. I had a nice little audience listening to me, so that made the playing worthwhile =) I'm glad that being able to play the violin has made this rotation more enjoyable.