FL_Medic Posted June 4, 2009 Posted June 4, 2009 (edited) Strip Tease 11 LARGER VIEWING To increase the size and make text or images easier to view hold down the Ctrl key and scroll your mouse wheel up/down. You may also hold down the Ctrl key and tap your +/- keys. Edited June 4, 2009 by FL_Medic
mobey Posted June 4, 2009 Posted June 4, 2009 It is kinda fuzzy, and I do not have a solid answer but here is what I see: You could call it V-Tach based on Lead II But there is a RBBB V1 & V2 there may be P waves present V1 also makes me want to say Flutter. Anywhoo.... I don't really know. Amiodarone should sort it out LOL
p3medic Posted June 4, 2009 Posted June 4, 2009 I can't make it bigger on my computer for some reason, but my dx is 2:1 flutter w/RBBB.
Tom B. Posted June 4, 2009 Posted June 4, 2009 Another excellent case that illustrates the value of prehospital 12 lead ECGs for rhythm analysis. Wide complex tachycardia, rate of 150, with bifascicular morphology (RBBB/LAFB). Atrial complexes clearly visible in several leads (especially aVR, V1 and V2). The trained eye can identify 2:1 atrial flutter in lead III. Conclusion: 2:1 atrial flutter with bifascicular block (RBBB/LAFB). Treatment: Assuming the patient is hemodynamically stable, supportive care. Not to beat a dead horse, but this is another heart rhythm you wouldn't want to treat with antiarrhythmics, especially if the chief complaint was chest pain or syncope. Tom
Jeepluv77 Posted June 4, 2009 Posted June 4, 2009 I noticed that leads aVR, aVL, and aVF have what appears to be an ectopy of somesort on the second beat but I don't see any signs of it on any of the other leads. Any help with figuring out what's going on there?
mobey Posted June 4, 2009 Posted June 4, 2009 Not to beat a dead horse, but this is another heart rhythm you wouldn't want to treat with antiarrhythmics, especially if the chief complaint was chest pain or syncope. Tom OK I agree, if the Pt is unstable/symptomatic not to use amiodarone, but instead head for the paddles. But in a stable patient...... why not? <snip> Our results indicate superior efficacy with the higher dose of intravenous amiodarone for the routine treatment of acute atrial fibrillation or flutter in a coronary care unit setting. The divergence between the two groups after 10 hours suggests a sustained beneficial effect of prolonged high dose infusion as compared to low dose. http://www.pubmedcentral.nih.gov/articlere...i?artid=1768984 <snip> PRESCRIBED FOR: Amiodarone is used for many serious arrhythmias of the heart including ventricular fibrillation, ventricular tachycardia, atrial fibrillation, and atrial flutter. http://www.medicinenet.com/amiodarone/article.htm
Tom B. Posted June 4, 2009 Posted June 4, 2009 Because with bifascicular block, A-V conduction is limited to a single fascicle (in this case the left posterior fascicle of the left ventricle). If the chief complaint is syncope, you have to consider that the patient is probably having transient episodes of 3AVB. If the chief complaint is chest pain you have to worry about ischemia of the last remaining fascicle. Either way, you don't want to make the situation worse with an antiarrhythmic which could trigger 3AVB (and wipe out any ventricular escape rhythms). If the patient is stable, that's good! Why mess with a good thing? Tom
mobey Posted June 4, 2009 Posted June 4, 2009 Because with bifascicular block, A-V conduction is limited to a single fascicle (in this case the left posterior fascicle of the left ventricle). If the chief complaint is syncope, you have to consider that the patient is probably having transient episodes of 3AVB. If the chief complaint is chest pain you have to worry about ischemia of the last remaining fascicle. Either way, you don't want to make the situation worse with an antiarrhythmic which could trigger 3AVB (and wipe out any ventricular escape rhythms). Tom Thanks, I got some reading to do If the patient is stable, that's good! Why mess with a good thing? All these phrases get tangled, Stable, Symptomatic, etc, etc. Basically I am being taught this: If the patient is unstable (hemodynamically comprimised, constant chest pain, etc etc) cardiovert. If the patient is syptomatic yet stable (light headed, exertional fatigue, transient angina, etc) go for the drugs. If the patient is neither (palpitations, or unaware) leave them alone.
Tom B. Posted June 4, 2009 Posted June 4, 2009 As a general rule, I think we can agree that UNSTABLE > CARDIOVERT (provided it is not a compensatory tachycardia). I also agree there's a fine line between symptomatic and hemodynamically unstable and the terms should not be confused! Tom Thanks, I got some reading to do All these phrases get tangled, Stable, Symptomatic, etc, etc. Basically I am being taught this: If the patint is unstable (hemodynamically comprimised, constant chest pain, etc etc) cardiovert. If the patient is syptomatic yet stable (light headed, exertional fatigue, transient angina, etc) go for the drugs. If the patient is neither (palpitations, or unaware) leave them alone.
Kiwiology Posted June 4, 2009 Posted June 4, 2009 Highly interesting, looks like I have to join you in some reading Mobey
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