Rhythm Identification Help

[BEorP]

Again, I appreciate all the comments. I chose not to administer nitro to this patient based on the potential of causing hypotension that I cannot do anything to correct vs. no proven benefit of nitro. Unfortunately, this decision has been criticized by some above me.

Edited March 23, 2009 by BEorP

[p3medic]

She's 85, on and off cx pain, took a ntg w/o relief and has a resting tachycardia in the 140-150 range. Unfortunately we only have one lead to look at, however given this patients age and hx, it seems very, very, unlikely for her to be generating that heart rate at rest w/o it being ectopic in nature. With that said, I'd be very much interested in controlling her rate, but not before a 12ld....and an IV.

[tniuqs]

BEorP:

A question: do your protocols allow for Entonox for chest pain ? as some areas do, others not.

Decreasing pain/ anxiety can reduce endogenous catacholamine release, therfore reducing HR.

Heck one day (just anecdotal) we converted an SVT with Fentanyl alone (an applause heard from the crowd .. that in an ICU)

'wrmedic82'

Im assuming ( i hope lightning doesnt strike me by saying this) this is a 3-lead strip. Since 12-lead is unavailable. I would say you can take the LA lead and place it where V1, V2 ect to look at individual leads. Takes more time and not as reliable..but its something to go by to give you an idea.

Multiple leads not a bad idea to develop a working Dx, but correct me if I am misunderstanding something but is LA (left arm) not a ground lead ? with Lead selection settings on the monitor in Lead 2. If selected in Lead 1 LA would be a positive lead .... get my point ... one could be really confusing the situation, unless one has a very good handle on 12 leads (ps thank God for the colours/letters/numbers)

With no Line, Chest Pain and a Tachycardia ... probably best do this while enroute an idea to place some defib pads as well (the if I waste 80 bucks then I will not need them concept) this wards of VTach spirits too ...

Now as far as giving nitro to the patient w/o IV access. Thats a judgement call you would have to make based on how the patient presents to you. If they are a bit tachycardic and they have the systolic above 110, you can give probably 1 spray and might be able to get away with it.

Then again you may just bottom pressure not disagreeing yes`a judgement call, I personally would look to LOC over B/P (pt has alread had one spray in the senario)... no pt weight, no size mentioned (I have seen many small elderly females with Normal B/P 90/60) just saying.

<snip>

Trendelenburg could be an option to help raise BP, not that Im a big fan of Trendelenburg as I have read in a study that it can cause more harm than good.

There is FAR more than one study to clearly indication that Trendelenburg is absolutely useless, if pt did have a component of CHF you could be making things far worse, then that could really change outcome. Besides someone c/o of CP will rarely want to lay down, let alone head down.

(in a nutshell by placing patient in trendelinberg, fluid shifts to the torso, thus tricking the body to thinking it is ok, and stopping the release of catechlomines. so once patient returns in the ER to a semi fowlers postion, the body has a difficult time catching up)

Umm HUH ? sorry, not even close to a rational physlogical explanation, (tricking ?)

I believe your trying to explain postural hypotension in a round about way, in fact, if one finds a 10% decrease in Systolic pressure (Sitting vs Supine) this can be a clear clinical indicator that the pt. has a fluid related problem. DRY!

And for those spell checkers out there I will say this in advance.. Bite me lol

Your welcome, google is your friend.

cheers

Edited March 24, 2009 by tniuqs

[firedoc5]

AZCEP, I agree. ST with BBB. Treat complaint(s)

And actually, I'd move the lower lead over to see if you can get a more clear picture.

[mobey]

What is being discussed is known as a 9 lead ECG.

Basically put on the 3 limb leads and do as follows.

Print lead 1

Print lead 2

print lead 3

Leave machine in lead 3 monitoring, and move Lead 3 to position of V1, creating MCL 1 (modified chest lead 1)... print strip

Move to V2 postiton for MCL 2, print

Move to V3 position for MCL 3, print

Move to V4 position for........ OK I am sure you get it.

Anywhoo..... arrange all you Limb lead printouts and MCL printouts like a 12 lead (although you are missing the augmented leads)

You now have a 9 lead ECG.

FYI, if you have a LP12 with 4 leads, but no protocol or wires to do a 12 lead, just put the 4 leads on the limbs and press 12 lead twice, it will print lead 1,2,3, avr,avf,avl. Hey.... gives you somethin!