ECG for discussion

[island emt]

Caduces"

The difference between you and most of the other teens that come here is that you really have the desire & passion to learn and improve your knowledge base.

You're also willing to put forth the effort to interact as an adult. Moat of the professionals are more than willing to share the decades of experience with someone who wants to learn.

Are you home schooled by chance?

there will be times when we push you to do more research rather than answer a question for you.. Thats how to learn.

Don't stop being curious, as long as you live.

I am always glad to see there is hope for the next generation.

Edited April 20, 2014 by island emt

[Caduceus]

Yes I am homeschooled I'm glad that I'm making a good impression here. I will continue to do so in the future and thank you again.

[m3d1c_89]

I agree with the general theme of the comments here. I would like to add is I believe you should never 'diagnose' a rhythm based on rate or let the rate be the deciding factor when you're thinking "It's either rhythm A or rhythm B" unless you're referring to something like this where you'd think Junctional Rhythm or Accelerated Junctional Rhythm.

Another thing I'd like to add about this rhythm is I believe the focus is just narrowly superior to the bundle of His/inferior most aspect of the atria. You see absent or inverted p-waves on all leads except V1-V2. V1 has VERY minute upright p-waves for every QRS and V2 has barely distinguishable p-waves with even less amplitude than V2 and very well hidden.

Finally, the only other things I noticed, which I can't be confident in because the tracing is not as clear as it would be in-hand, to me it appears V2, and V3 seem to have S-waves that (most noticeably on the 2nd complex, but present in all 3) slur before returning to isoelectric line. MAYBE a possible q-wave formation or early stage development of a BBB? Slurring of R-wave in V4, again, most noticeable in complex 2 but present in all 3.

[1EMT-P]

It is hard to really tell with the quality of the ECG, but the P waves appear to be inverted which suggests a junctional rhythm. I did notice that the P waves appear to be upright in both V1 & V2. I would like to know more about this patients history & medications.

[Levi]

I'm sure you were joking about leaving her at home, right?

Junctional rhythm about 75/min

Regular

Axis normal

No acute ST or T wave changes

Don't see any pathologic Q waves

Give her two hardenupacetomol and leave her at home.

[paramedicmike]

Don't mind him, Levi. He's not a health care provider. He just like to pretend to be one.