I would like your opinion about a funky EKG

[Ridryder 911]

The "QRS" are regular, until mid-way. Also appears to be a prominent "P" wave although the morphology is different and appears to come from different foci. This may be contributed from movement or poor electrical conduction.

Be safe,

R/R 911

[1EMT-P]

I agree there does appear to be QRS's until the mid point & there also appears to be P's.

[DontFearTheReaper]

I'd say Atrial Fib w/PVCs. The cardio nurse here agrees with me.

A-FIB ????? Way to regular. Cardio nurse--- I see your cardio nurse and will raise you a cardiologist. LOL

[baasmedic1119]

I'm definitely seeing P-Waves. However there are several different morphologies of them. I definitely think this is a strip that you need a lot more to come up with a good interpretation. But the big thing is, Is Your Patient symptomatic????? Treat the pt, not the monitor. I do not agree with the sick sinus syndrome, I was always told it was not something you could diagnose with a 3-Lead EKG. I thin kyou are looking at an SVT in the first part of the stip. There is definitely a different rhythem towards the end! Maybe a junctional rhythm. Definitely looks like PJC's though!

[Thunderchild145]

I still gotta say those dont look like P waves. PNT or V-tach in the beginning I'd say. Either that or just too much artifact. I still have to go with my A-fib with PVCs in the second rhythm.

[hammerpcp]

baasmedic1119 wrote:

[spoil:9ace5ecd14]I do not agree with the sick sinus syndrome, I was always told it was not something you could diagnose with a 3-Lead EKG[/spoil:9ace5ecd14]

You can't actually diagnose anything with a three lead ECG, you need a twelve or fifteen for that. three leads are designed to cause arguments among BLS medics and to confuse fire fighters.

[hammerpcp]

what the hell did i just do?

[akroeze]

what the hell did i just do?

I don't know, but I suggest you get out of town as fast as possible :shock:

[vs-eh?]

I still gotta say those dont look like P waves. PNT or V-tach in the beginning I'd say. Either that or just too much artifact. I still have to go with my A-fib with PVCs in the second rhythm.

Ummmmmm....

1) What is PNT? I've never heard of that...Paroxsysmal Normal Tachycardia?

2) V-tach? Ummmmm....All things being equal knowing nothing about the patient and not having a 12 lead...If you were to show this lead 2 strip to anyone educated in rhythm interpretation you would be very very very hard pressed for anyone to say the initial rhythm was a V-tach. What would lead you to that? QRS is within normal limits (again lead 2 and likely in a non-diagnostic mode) and *whispers quietly* V-Tach will show p-waves as well (at times). It is just that normal conduction is being overridden by ectopy. Take a look at what V-tach normally looks like in lead 2 monitoring. While I would never say beyond a shadow of a doubt that it is not VT, even playing odds (which is what you would do in this case) I don't think anyone, if that rythym continued, would treat as Vtach.

This strip appears to be a "conversion rhythm".

Call it an SVT. The term SVT actually encompasses (technically) a lot of tachy rhythms, and not just the one that most people would give adenosine for :wink: . Sinus tach is technically an SVT...

SVT that is converted to another rhythm that appears to be in a bigemeny. Bigemeny is pretty clear I think.

[Thunderchild145]

Close. Paroxysmal Nodal Tachycardia. Originating in the AV node. PNT is a type of SVT also. As far as the V-tach. Your right. I was tired when I posted that and had sleep in my eyes. I'll prolly let this debate be carried on by people more skilled than I to do so. =)