scott33

Rise above it. He is either trolling or, as you say, just a sore loser having sat it several times and failed. Three of his posts say the same thing about the NR with no rhyme nor reason. He is obviously begging us to go after him, which is why I would just ignore him if he continues to post one-sentence antagonistic diatribe.

Thanks for sharing. I have just landed back in the US only yesterday, having buried my Father last Thursday who succumbed to Colon Ca with liver mets. I intend to get a colonoscopy in the near future even if I have to pay for it myself.

Also, if you consider atrial rates in AF, vs atrial rates in MAT - as well as other physiological differences such as cardiac output, you will see that AF and MAT are very different in many ways. AF often produces the "quivering atria" due to completely random impulses firing at such a rapid rate, from any and many foci within the atria, and of which only a fraction will result in conduction throught the AV node. With MAT, the impulses are more organized and individually, are more likely to continue conduction through the AV node and beyond - hence the P-wave (or similar) before every QRS. Sorry, completely different.

How about "D. Live Stud" (Can anyone hear the Jeopardy tune in the background?)

It's all in the eyes. There have been studies done which claim that if the patient has their eyes open (or flickering) during a seizure, then it is neurogenic in nature. Conversely, if the eyes are closed it is more likely to be a psychological event (pseudoseizure). Apparently the studies are so predictable as to be almost diagnostic. It is now one of the first signs I look for when I see a witnessed seizure, and I have, on one occasion, said out loud in front of patient and family - "We will be here for you when you have finished", to a young girl with her eyes screwed tightly closed and no loss of continence. Funnily enough, she made a "miraculous recovery" with no post-ictal phase a few seconds later. Eyes, eyes, eyes. It's almost all you need to know. http://www.webmd.com/epilepsy/news/2006061...ogical-seizures http://thelastpsychiatrist.com/2006/06/pse...s_seizures.html http://drkatie.wordpress.com/2008/07/26/pseudoseizure/

Yeah they are not the most obvious P-waves, but they are p-waves. The atypical morphology could either be as a result of depolarizing right at the terminal end of the unusual S-T segment, or perhaps something as simple as the patient having atrial hypertrophy - something you can pick up on one lead, and not inconsistent with her history. I will stick with my first, first answer - sinus tach. Treat her for her chief complaint.

Any congenital septal defects, or recently diagnosed defects in the septal wall? Possibly a thrombus (or thrombi) was dislodged from the venous circulation in the legs, and traveled to the arterial circulation through the defective septum (thus bypassing the lungs and a PE) and causing both CVA /TIA and MI Do I win?

Sinus tach, or another MAT As above, treat the symptoms, and do a 12-lead for a closer look

JVD? pedal edema? acites? Heart sounds if you do them? Right sided-EKG?

Can you just explain how you found that, and its clinical significance. I can't see any of what you are saying. --------------------------------------------------------------------------------------------------------------------- Did we get lung sounds?

Ehh...say what?

Is he complient with his meds? Did he take them all today? Any pain?

Oh dear. Inferior wall MI. Lead III has taller ST elevation than lead II, so I would want to rule out any right-sided involvement, in spite of the decent B/P at this point

Please tell me you are joking.

I agree with atrial flutter with a 3:1 conduction ratio. Tiny QRS complexes in spite of increasing the "size" to 1.5 x normal - did the pt have COPD? Also note the rate is exactly 80...Hmmm, would like to see the 12-lead to look for axis and BBBs. In lead II you have no clue

This practice is highly outdated and based purely upon a couple of instances of it ever happening. You are more likely to die from the latex-induced allergic reaction than have rubber piercing your brain. It's kind of like doing away with all IV access, due to the possibility of introducing detached catheters into the venous system - such as mentioned elsewhere The NPA / head trauma contra is just one of the many old practices, which should either be reviewed (ie use cation) or abolished altogether. There are far more examples of potentially dangerous practice which we perform daily without a second thought.

What benzos do you carry? We occasionally have given Valium as a discretionary order for trismus, given we don't allow nasal intubation.

I agree with all you have said. But 18 days is positively eons compaired to some of the Private firms in the UK which offer a 5 day (8 hours per day) EMT course. Not really relvant for here, but it always has me laughing one minute and pissed off the next. The lack of regulation of the name, and the desire to hoodwink the public into thinking they have something relevant to ambulance work, has created many not-at-all-like-the-real-thing courses, which usually teach you not much more than how to obligate yourself to show up the scene of MVCs, in a flap, with that "all out of breath" look. Some of the many link that Google will spew up. http://www.interdive.co.uk/diver-courses.asp?course=210 http://www.crownmedicaltraining.co.uk/docu..._Technician.pdf http://www.era-adventures.com/firstaid.php#technicians http://www.norvic.biz/courses/docs/pdfs/fa...cian_course.pdf PS, they are open to anyone.

I think you have misread something somewhere. It is neither 18 hours, nor does it give a license at the end of it. Not that I am advocating taking these courses

Probably because their instances of missed tubes (or rather, missed tubes left in situ) are so insignificant as to not warrant it. Probably because RT's and Anesthesiologist do enough tubes to take the guesswork out of intubation and end tidal monitoring. Probably because a hospital bed is a lot less bumpy than an ambulance or a flight of stairs.

This has been mandated as the standard of care in my part of the world since January. You can't tube if you don't have the ability to provide a waveform. I still think it will only go a small way to delay the inevitable - the loss of ETI for medics (other than the critical care / flight teams)

No doubt.

It almost sounds surreal to read that out loud. But boy, is that progressive.

MAT = Multifocal Atrial Tachycardia WAP = Wandering Atrial Pacemaker

Surely an a-fib that contains discernible P-waves, cannot be called "A-fib"