Abberancy or VTach?

[firefighter523]

I would just be leary on giving adenosine to someone with a BBB, don't know what it would do. I know what it will do with someone with a block higher up above the R and L bundles, but not lower, sorry.

[jwraider]

I'm in school now (cardiology division even) and these are the absolutes we were taught to differentiate a wide complex tach from VT or a SVT.

See VT in II

Look @ V1

If mostly positive:

-- monophasic,biphasic QRS = VT

-- Triphasic = SVT

( confirm by looking in V6, QS complex or deep wide S = VT)

If mostly negative

-- Wide R wave, delayed nadir, slurred downward slope = VT

-- Ski slope (very steep straight downward slope)= SVT

(confirm in V6 any Q wave = VT)

Some of those terms ae probably specific to my teacher. She stated these rules are 99% accurate.

Looking at this 12 lead I'm going VTACH due to the mostly positive complex in V1 being biphasic and a deep wide QS complex in V6.

Would be interested to hear back since I'm just learning!

[Dustdevil]

Some of those terms ae probably specific to my teacher. She stated these rules are 99% accurate.

Did she also mention that 87.3 percent of all statistics are made up on the spot, with no supporting evidence? :wink:

[Trauma612]

I thought it was 86.4%? oh well

I think the gain was just up to high and it's actually just sinus tach :roll: kidding, But Im not seeing SVT in that in any way nor would I treat it like that.. but that's just my eye's

[tribalmedic148]

This is clearly V - TACH, on your twelve lead it meets all the requirements to be so. for instance. all three limb leads point down and V1 points up. this is 99% diagnosed as V -Tach. if in dought look at V6 it points down showing you the direction of impulse is going away from lead so impulse has to be ventricular in nature. Oh by the way everything on 12 lead is wide so no dought this is V-Tach.

[Aeromedic]

I'll have to scan and post a strip that looks VERY similar, except my patient looked a bit pale and said she felt "kinda weak and a little bit dizzy". Extensive Cardiac History, meds took up half a page of my PCR, but yea, her pulse felt rapid on initial and she said she wanted to walk, she didn't want to be carried. When I got her on the monitor I nearly soiled myself, as it was my first time seeing a vtach that wasn't pre-code. Called for adenosine but the doc decided that as long as she was conscious and stable to let it run, set up to cardiovert if needed but rapid transport and have a cardiologist waiting.

As for this one, yea, its V-Tach. Rate + Form + Duration = V-Tach. I would be very comfortable with that as my differential when I got to the ER.

[EMS49393]

This is clearly V - TACH, on your twelve lead it meets all the requirements to be so. for instance. all three limb leads point down and V1 points up. this is 99% diagnosed as V -Tach. if in dought look at V6 it points down showing you the direction of impulse is going away from lead so impulse has to be ventricular in nature. Oh by the way everything on 12 lead is wide so no dought this is V-Tach.

Really? Because it looks to me that lead I is an up, not down. So, no it does not meet the requirements, as previously stated.

[mobey]

As I have just learned, determining "true" V tach is not my strong point.

If I were presented with this patient, I believe I would treat with 150mg amiodarone, and have another look.

I too would transmit this to a cardiologist for advice.... of course I have a 3hr transport time.

[ERDoc]

So for this resurrected 3 year old thread, here is a link to the Brugada study from Circulation.

http://circ.ahajournals.org/cgi/reprint/83/5/1649

On page 1651 is a nice decision tree that I think can help us decide what this is.

1. Absence of an RS complex in all precordial leads?

I would have to say no. I would say that both V2 and V3 has RS complexes (though the R wave in V3 is very small but it is still there). This means we have to move on to the next decision point.

2. R to S interval >100ms in one precordial lead?

We have to look at 2 leads, V2 and V3 since they are the only precordials with RS complexes. We look for the largest interval starting at the beginning of the R wave to the deepest part of the S wave. We have R to S intervals of 160ms and 40ms in V2 and V3, respectively. Based on this we can call it VTach and don't need to assess the remaining two criteria.

For those who are interested in the statistics, the Brugada criteria give us a sensitivity of 98.7% and specificity of 96.5% for VT and a sensitivity of 96.5% and specificity of 98.7% for SVT with aberrancy.

[Tom B.]

Really? Because it looks to me that lead I is an up, not down. So, no it does not meet the requirements, as previously stated.

You cannot use the frontal plane axis to rule out VT. This kind of thinking is extremely dangerous. Wide and fast is VT until proven otherwise! This ECG shows RBBB morphology in lead V1 and left axis deviation. In other words, bifascicular morphology (RBBB/LAFB) which is the exact morphology we could expect if the VT originated in the left posterior fascicle of the left ventricle. In other words, one of the EXPECTED morphologies of VT. ERDoc used Brugada's critiera in the only responsible way, in my opinion, and that is to rule-in VT. Failure to rule-in VT does not rule-out VT and these criteria do more harm than good, especially in the prehospital setting.... by a large margin.

Tom