The Evolving Patient (ECGs!)

[scott33]

Just to repeat what others have said.

I am not sure this is VT. Lack of extreme right axis, lack of concordance in the V leads, and lack of morphological criteria in V-1 and V-6.

Amiodarone either way

The patient is without change in any other aspect of presentation. He does not seem to notice what the monitor is saying.

Did you try thumping the monitor a couple of times? #-o

[Dustdevil]

Did you try thumping the monitor a couple of times? #-o

Ha! This is such a textbook progression that the first thing I thought was that somebody left the monitor plugged into the training computer and it was not the patient's real rhythm.

I would called the the first trace ventricular bigemany.

And you would be called in front of your medical director immediately after doing so. It is TRIgeminy. :wink:

I have seen this sort of dysrythmia converted by speed bumps (do you have those in the US?).

Not only in the US, but we have exported them to Iraq too. The MPs lay used tank treads across the roads on camp to act as speed bumps. Idiots. :roll:

Still the point Im trying to make is these patients can become very ill very quickly so dont piss about.

LOL@piss about

That's very true. There is a good chance that this guy is going downhill from here without pharmacological intervention. Sure, there are a significant number of spontaneous terminations without intervention, but I'm not waiting for V-Fib before I jump in. Tis time for a dose of the bubbly!

This is definitely V-Tach. Overlay one of the complexes over one of the PVCs in the initial strip. There ya go. And there is no bundle branch block.

[irme]

I thought he was 56??

How much does incorrect age on 12 lead affect the results??

[Dustdevil]

I thought he was 56??

How much does incorrect age on 12 lead affect the results??

Ha!

Maybe he just really looked young to the crew? I know when I was in my accident, the flight crew called ahead and reported they had an "approximately 18 year old male" and I was 33 at the time. :D/

[rdenman26]

"]I would called the the first trace ventricular bigemany.

And you would be called in front of your medical director immediately after doing so. It is TRIgeminy. :wink:

Good point well, presented

[danielir]

This is definitely V-Tach. Overlay one of the complexes over one of the PVCs in the initial strip. There ya go. And there is no bundle branch block.

Thank You...Although there IS a RBBB, if you take a look at the 'regular 12 lead' that fiznat posted.

The rhythm is clearly ventricular in origin. The complex is in fact quite wide, and the initial rhythm of trigeminy shows that there was already an irritable focus somewhere high in the ventricle, which accounts for the axis and the 'normal' R-wave progression in the precordial leads.

[rdenman26]

Before any one points it out, I know I put the puntuation mark in the wrong place in my last post. I really must learn to concentrate more when I'm typing. :oops:

[Dustdevil]

Thank You...Although there IS a RBBB, if you take a look at the 'regular 12 lead' that fiznat posted.

Just curious what leads you to believe there is an RBBB. I don't think there is, although I accept that this is a tiny ECG copy that isn't very clear and goes to crap one beat into V5 and V6. Makes it a little hard to count tiny boxes.

Although, what I specifically meant was that there was no LBBB, as was mentioned by a earlier poster.

[fiznat]

I can post bigger copies if you guys want... I just thought I'd go easy for those who dont have huge monitors and fast internet connections.

Dusty-- why cant there be a LBBB? The deflection is in the right direction in V1 and I dont think anyone would argue that the QRS is wide enough....

Huh, by the way, anyone notice that the arrangement of the limb leads on the printout is a little odd? I wonder why my friend has his monitor set like that... I just noticed myself.

[jjones1418]

I think we're losing track of what's going on with the patient. It's looking for zebras while the horse kicks you in the face. He's in a wide-complex tachycardia at 215 bpm. It's VT. The morphology matches the PVCs as dust says.

I don't see the RBBB either. I don't think it matters. This guy is sick, and he needs pharmacological intervention. I like how Dust alluded to his agent of choice as "bubbly." I like our prefilled syringes. No drawing up that stuff.

Of course we could wait 'til that heart of his decides v-fib is a pretty line to draw on the monitor while we attempt to diagnose Lown-Ganong-Levine syndrome with WPW and a tri-fascicular block. We can ALL treat V-fib, right!? /sarcasm