I would like your opinion about a funky EKG

[EMT6388]

I'm not really sure where I should put this post because in our service 3 lead EKG is a BLS skill but I do realize that a lot of places it is an ALS skill and I am interested in the opinions of EMT's and Medics experienced with EKG's. With that said if your just learning feel free to take a stab at it. You only get better with practice.

A little while back my partner and I ( both EMT's ) were called to local the nursing home for a 98 y/o male pt c/o SOB. My partner had been to this gentleman previously and said that he has a previous cardiac Hx so we brought in the monitor. O/A we found supine in his bed, a little lethargic, obvious signs of SOB other than a SP02 of 92%. All vitals were WNL. No past medical Hx other than a previous MI. Pt was place on oxygen and a 3 lead was done due to the previous cardiac Hx. This is what we got. (sorry if the Hx was a little vague but this call happened a few months ago. A few days ago I came a cross the PCR and wanted some more opinions about it since are staff had a few different interpretations of it)

Sorry if the quality of the image is not the greatest but I scanned it from a photocopy of the original PCR. Also for our documentation we have to put our interpretation on the bottom of each strip so that is what those marks at the bottom of the strip are. I tried to crop most of it out with out cutting out any of the rhythm.

Any help anyone could give me would be greatly appreciated. Thanks in advance!

[DontFearTheReaper]

can not get link to work.

[emt3225]

Hello...I'm not able to open your website... :?

[vs-eh?]

Very tough to tell....

The initial rate looks pretty regular narrow complex @ 150 until about the 7th or 8th complex. Call it what ya call it to there. Are those p waves? Are they burried? Meh...

Then it looks like there was potentially a p-wave with no QRS...Then we go into the other rythym...

Did those reduced amplitude complexes conduct? Looks almost like a bigemeny...

I dunno...SVT into a junctional escape rythym with ventricular bigemeny...

Very very likely wrong.

No meds? Would help.

[vs-eh?]

http://photobucket.com/albums/e268/emt6388...nt=WierdEKG.jpg

[emt3225]

All i can say is WHAT THE HELL...I have never seen a ekg that looked like that...Did the man have Parkinsons?

[EMT6388]

No, he didn't have parkinson's, but somthing must of been happening because he is since deceased. But then again he is 98

[DontFearTheReaper]

WOW a toughie..

My poke at it is SVT into a junctional rhythm with bigemeny PJC's????????????

Would be a good one for doczilla or erdoc to look at. Or any other MD, DO also.

[Ridryder 911]

Ditto with the rest... the rate is pretty fast for a accelerated junctional rythm.. although when I first lookes at it, I thought the same. I believe it has some fusion beats or ectopic beats to convert the pattern. Funky pattern, but with the age of the patient who knows.... I am sure there is an electrolyte imbalances etc... also, my rationale is ... he is 98 years old .. he has earned any funky pattern he can have.. :wink:

[EMT6388]

Thanks everyone. I was thinking the same as everyone else here so that's good. This one was definaltly a learning one!