Strip Tease

[Canadian Caesar]

Ok does this pt have a pulse? I dont think so, its v-fib shock it

HINT: I spy with my little eye... a QRS complex or two.

[CBEMT]

Ok does this pt have a pulse? I dont think so, its v-fib shock it

Heart rate of 80 and an SPO2 of 94%..... yeah dude, go for it. Here, let me set it to 360 for you.

[AnthonyM83]

When you save it to your computer, then zoom in, do those F waves seem to have little dips at the top of them. Is that just how they look sometime or is there something hidden in them (probably not, just throwing it out).

As far as the rhythm, I see what Spenac sees. The PVCs are spaced out pretty regularly, too.

?

[fiznat]

There aren't enough leads to tell for sure, but my first impression was a-flutter as well. It is a little funny though. Here is a zoomed in version so I can explain:

If we are going to call the taller, wide complexes (hashed by the top lines) the underlying rhythm and the in-between beats the "flutter" waves, those flutter waves should all have the same morphology. It doesn't seem like they do. Note the complexes that I underlined (bottom hashes). Those appear to be much narrower complexes also in a regular pattern. Perhaps this is actually the underlying rhythm?

Edited March 17, 2009 by fiznat

[WelshMedic]

My intial guess would also be AFlutter. However, as we all know folks, treat the pt. and not the monitor. What did this pt. present with in terms of symptoms?

I'm not sure I'm even going to do much with this rhythm as long as my patient is haemodynamically stable.

We don't cure 'em, we just haul 'em in!

The above may sound fairly flippant, but I do firmly believe that doing no further harm is an important tennet in our work. The good clinician is not the one who takes every trick out of his bag just because he can, the good clinician is the one who weighs up the benefits for the patient. An so also knows when not to do something.

WM

[crotchitymedic1986]

Next time, ask the medic to move the leads around or turn up the gain, so that a clearer strip can be obtained. A.Flutter would be first guess, possible BBB, possible electrolyte or medication induced abnormatlities.

[FL_Medic]

Blue arrows indicate T waves

Red/Yellow arrows indicate R-R interval

4:1 Atrial Flutter

[AnthonyM83]

Next time, ask the medic to move the leads around or turn up the gain, so that a clearer strip can be obtained.

I don't think he had that option . . .

Blue arrows indicate T waves

Red/Yellow arrows indicate R-R interval

4:1 Atrial Flutter

Four to one? So is one of those Flutter waves hidden in the T-waves (which would explain why they're so big and notched?)?

[fiznat]

hah! I picked out the right QRS! In all of your faces!!

Good strip.

Edited March 18, 2009 by fiznat

[FL_Medic]

Correct, there is an F wave hidden in QRS, in the T wave, and there are two before each QRS.