FL_Medic Posted May 23, 2009 Posted May 23, 2009 (edited) Okay, this one isn't on my blog yet. Thought I'd get another one up quick because the last one was answered so quickly. Instructions for larger viewing from FireEMT: If you enlarge the image when you click on the part where it says to click to enlarge and it opens a new window click and hold the control key on your keyboard and then hit the + key. It will enlarge the image even larger as many times as your click it. If you do the same, but use the - key, it will make it smaller. This also works for normal web page viewing. It works in firefox, and internet explorer. Edited May 23, 2009 by FL_Medic
Kiwiology Posted May 23, 2009 Posted May 23, 2009 Aw jeez ...here's what I see - its a regularly irregular rhythm of about 50 - looks like AF - could be a ventricular rhythm or third degree block
Jeepluv77 Posted May 23, 2009 Posted May 23, 2009 To my not quite trained eyes it looks like a 2nd degree type 1. Hard to tell because it's so slow and there are only 2 p waves and 2 qrs complexes. But I did noticed the second pri was much longer than the first. However, I could see it also being a 3rd. Those that are more experienced will probably be able to tell, but this is when I'd be hitting the print button on my monitor and getting a lead II print out. As far as treatment, would you pace? I'm guessing atropine wouldn't work if it's a block. We were taught it only works for brady originating above the av node.
Niftymedi911 Posted May 23, 2009 Posted May 23, 2009 Adam, Its a complete heart block with artifact. It actually threw me off thinking it might be A-fib with the complete heart block, but if you look closely there are numerous P waves found in the pericordial leads. They don't map out, giving way to complete AV dissocation, meaning complete heart block. Atropine is not the treatment of choice here. If it's asymptomatic, you watch and monitor close. If he's symptomatic: postion of comfort, NC @ 2-4 lpm O2, IV access, have someone ready the pacer and apply it, begin pacing and start a dopamine drip 5-20 mcg/kg/min for perfusion. Repeat 12 leads while enroute with ETCO2, SPO2, BGL, and Temp monitoring.
FL_Medic Posted May 23, 2009 Author Posted May 23, 2009 3rd degree(Complete) AV heart block. Note P-P intervals stay consistent. R-R intervals generally stay consistent with these AV blocks as well. There is complete AV disassociation. This is why the QRS complexes widen with complete heart block.
ERDoc Posted May 24, 2009 Posted May 24, 2009 Third degree with BBB. Which type of BBB and where do you see it?
Fifthkid Posted May 24, 2009 Posted May 24, 2009 Which type of BBB and where do you see it? Right BBB seen in almost all leads to me
ERDoc Posted May 24, 2009 Posted May 24, 2009 Right BBB seen in almost all leads to me You are not getting off that easy. What do you see in all leads that says RBBB?
HellsBells Posted May 24, 2009 Posted May 24, 2009 It is a LBBB, as the QRS is wide (its borderline at 0.12 sec), negative in V1 and the underlying rhythm is supraventricular in origin
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