Strange ECG

[AZCEP]

Fair enough.

Just looking for an explanation that I might have missed.

I would also expect Vtach to be faster, but a rate of 126/min would not typically be fast enough to cause a rate related aberrancy either.

[1EMT-P]

What's the patient's GCS? What's his skin color & condition? What's his vital signs? Does he have any allergies? Does he take any medications? What's his Past Medical History?

It appears to be V-Tach :!:

[Rezq304]

I'm going with V-Tach on this one too. Depending on what the patient condition is depends on whether I go pharmalogical or electrical initially.

[amitzahavi]

Why would you say this is V.Tach and not A.F ?

Patient info:

56 y.o. male

Complaining of palpitations in the last hour. Went to see the doctor, he called us.

Vitals:

BP 120/80

Pulse 126

Skin Normal

Resp. 14 - 99%

Lungs - nothing special

GCS-15

When we arrived- more palpitations and feeling of discomfort.

[Rezq304]

Just my opinion and I'm still learning, but that rhythm looks to be "regular" to me. At least, as regular as it can be. Just doesn't appear to me like an A Fib.

[mediccjh]

The rhythm is regular, and that's measured with my trusty calipers. That rules out A-Fib.

The wide QRS can be explained by a bundle-branch block. You can see the notch in most of the leads.

The P-wave can be buried in the T, so I'm calling it Sinus Tach w/ BBB.

[medic001918]

The rhythm is regular, and that's measured with my trusty calipers. That rules out A-Fib.

The wide QRS can be explained by a bundle-branch block. You can see the notch in most of the leads.

The P-wave can be buried in the T, so I'm calling it Sinus Tach w/ BBB.

That's more along the lines of what I was thinking then V-Tach. I wouldn't treat this rate or rythem with electricity or and cardiac meds. Try a bolus of Normal Saline, supportive care and a ride to the hospital with more assessment of the patient.

Shane

NREMT-P

[fiznat]

Ah ya beat me to it!

Yeah its a wide complex, tachy rhythm with hard to see (if existant at all) p waves. The bundle branch is also fairly obvious, which does help to explain the width. They've been telling us in medic school that any wide complex tachycardia like this should be assumed as VT unless proven otherwise. Amio would of course be the perfect drug for this patient since it work either way-- the only problem is if it does work, you still dont know what the rhythm was.

Also is it just me, or are those T waves a little tall? Possible hyper-k?

[AZCEP]

When DE-polarization is abnormal, RE-polarization will be abnormal

[fiznat]

woah woah there. I can read regular sized text just fine.

My understanding is that hyperkalemia usually results in an abnormally wide QRS, flat P waves, and tall peaked T waves. I dont see why the combination of hyper-k and bundle branch couldnt produce the rhythm posted. Just because the QRS is abnormal doesnt mean that the T wave is insignificant.

Of course hyper-k is pretty much a Dx of exclusion in this case. No medic of sound mind I think would jump right to calling this hyperkalemia... doesnt mean it isnt a possibility though. The S+S are there, the EKG supports it, and its one of the "H's and T's." We should consider it, along with everything else.