I would like your opinion about a funky EKG

[RaceMedic]

:twisted: defininitly PCL...... pre code looking .....LMAO

[vs-eh?]

It is not afib with ectopi, I don't know why people are saying that...

[firefighter523]

SVT into a junctional rythym with PJC's ( I agree with the conversion ) The r to r's are spot on regular in the begining..

[bassnmedic]

Looking at this strip, the first thing I noticed was that the "p" dissociation with the QRS complexes in the beginning...and the different morhology of them which might lead one to suspect maybe Multi-focal Atrial Tachycardia. Now, on to the second section of strip.wow!.the rate is right for junctional, there are definitely premature complexes involved but i doubt they are junctional escape beats but they could be. there does appear to be p waves with some of the QRS complexes, my best guess would be sick sinus with pvc's.

[hitman98]

it's a fib

[The Hook]

Looks as though the rhythm goes into either a bigeminy of beat...pvc...beat...pvc.

If not then perhaps electrical alternans.

Was each qrs spike a perfusing beat? Was there an accompanying pulse?

IV, O2, Transport, Nitro if BP is up.

Is pt on Coumadin/Warfarin? If not then Aspirin.

No pain indicated? No MS needed.

How acute was the onset of SOB?

[The Hook]

I am a new Paramedic so please bear with me everyone. I am seeing a lot of A-Fibs with ectopy though I am not seeing the trashy baseline that was such a distinguishing factor in determining A-Fib. If we are seeing varrying shapes to the P wave then is it not simply multiple foci from the atria?

Any advice or a quick tongue lashing would be appreciated!

The Hook

[chbare]

The hook, I see what you are talking about, however, like Dustdevil pointed out, the P waves and complexes do not appear to march out. I would have to go with A-Fib for the underlying rhythm. However, I do work ER and 70% of what I see is runny noses and earaches, so take my word for whatever you think it's worth.

Take care,

chbare.

[boneknuckleskin]

Nah, I'm with you, Intothis, and CHPmedic. I am confident it is A-fib with ectopi. Neither the P's nor the complexes march out. Close, but not quite.

So make that a cardio nurse and a pedi nurse saying A-fib.

You're all wrong. Especially you.

Can any of you highly educated EMT-paramedics explain how it would be possible for PJC's to co-exist with a underlying junctional rhythm? Or PAC's within PAT? Or PVC's during the occurence of VT? Enlighten me.

Dustdevil's interpretation of P's and R's that just "don't quite" march out doesn't qualify it as A-fib either. I might know, because in addition to my intermediate training, I once upon a time I was employed as a ICU monitor tech --- and it's because of this that I can tell you the following three things with 100% certainty:

True A-fib will never present semi-regular.

More often than not, any 'ectopy' observed during A-fib is nothing more than aberrant conduction.

RN's are rarely the best judges of any rhythm.

If you were thinking A-fib but still dissecting make-believe P-waves that just aren't lining out, then you should be thinking more along the lines of WAP/MAT, in which the PR length will vary as much as the presence and presentation of P-waves will. At a glace, I'm inclined to learn towards a run of PAT followed by a bigeminy pattern of upper origin, possibly progressing into a wandering pacer, and then to stop glancing, because in a 98 year old heart, it doesn't really matter. They often run all the above, self converting between every rhythm and ectopy you can interpret, and some you can't - and at this point everything seemed to be supraventricular appearing, so treat the patient and not the monitor.

[Dustdevil]

Can any of you highly educated EMT-paramedics explain how it would be possible for PJC's to co-exist with a underlying junctional rhythm? Or PAC's within PAT? Or PVC's during the occurence of VT? Enlighten me.

I could, but obviously you do not understand cardiology well enough to understand the answer so I won't waste my time. I'll just leave you with one word to ponder: multifocal.

Go spend a week with the Dubin book, then a few months in a hospital reading 12 lead EKGs (not staring at a monitor), then get back to us if you still have any questions. If you have never seen A-fib present semi-regular, you obviously weren't a monitor tech for very long. Or else you simply sucked at it. I've seen it twice this week.

And barging in here to tell everybody they are wrong when you yourself can't even tell us what is correct is just plain stupid.

Oh, and occurrence is spelled with two Rs.

Minus five for not using spell check.

Minus five for replying to a topic that has been dead for four months.

Minus ten for the most horrible first post I have ever seen made on this forum.