Thursday, October 30, 2008

Shock Treatment

Lets face it... the practice of medicine has some dark chapters... and to many... electro-shock therapy of the 60's makes up one of the darkest. The images of patience strapped down... and basicly tortured is something that's seared into the american conscience to the point that its practically an architype. You have about a 50-50 chance of seeing some kind of shock treatment scene in any haunted house you happen to visit.

So let me tell you something you probably don't know.

Its still done. Its still done... because it works.

There are mountains of evidence that prove it works. Not just that it works... but what methods work best... all the way down to determining the peak level of effectiveness. The only thing we don't know... is why it works.

DrWho has often provided anesthesia for patients being treated. The whole thing is just bizarre to me.

First of all... the whole thing is very hush hush. The centers are usually very easy to get in and out of... patients frequently have a private door so folks don't see them coming and going. The stigma is palpable.

The major difference between moder shock therapy and what was endured 50 years ago is anesthesia. Now patients sleep through it... and not just that... they mostly even lay still... because they are paralyzed.

See the whole point is to flood the brain with electricity and induce a seizure. There are pretty strict guidelines about the length of the siezure... which effects the efficiency of treatment. On the other hand... the seizures can be so violent that the patient could be injured... so now anesthesiologists actually use very short acting paralytics.

Of course... if the patient is paralyzed... its kinda hard to tell how long the siezure is lasting ain't it?

So how did they solve this?

Well.. to be honest... some anesthesiologist was looking around and saw a bloodpressure cuff laying around. He inflated it on one of the patient's arms then gave the paralytic. The cuff prevented the drug from flowing into the cuffed arm... so they could watch the one arm flop around and therefore safely time the seizure.


Of course this all leads to some jolly great fun once one considers the possibilities. For example... unsuspecting nursing students... or rookie interns are almost always told to stand next to the cuffed arm... with predictable results.

DrWho still cracks up when she remembers this one chick nearly had to be resusitated after the arm jumped up at her.

Yes virginia... hazing still exists. Its just more elaborate.

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