Strange ECG

[hammerpcp]

Atrial fibrillation isn't always irregular. A rate of over 150 for V-tach is usually the number the monitors use to defibrillate. They will not shock at a rate under that, however it is possible that the pt still has a pulse above that. Thats why we check for a pulse (do we still do that?). Maybe that is why they've gotten you all so hung up on that number. :dontknow: It sure does look like V-tach to me.

[medic001918]

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?

Provided that my patient had a good blood pressure and is mentating well and doesn't appear to be hemodynamically comprimised, I still think I'd hold off before jumping to any kind of medication for this patient. Amiodarone would be a good medication since it works on atrial or ventricular rythems, but with a rate of approximately 125, is the rate really the issue? And does it need to be controlled? I'm sticking by my front line for this patient is oxygen and a fluid bolus before trying anything else. You could set the pads up in case you do need to defib/cardiovert, but my guess is that the patient would be stable enough to make it to the hospital.

And just for something to think about Fiz, don't forget about Procanimide since it works on both the atrial and ventricular rythems. We don't carry amiodarone in the city yet even though we have it as an option in our protocol. There's only certrain services that have it that we cover for.

Shane

NREMT-P

[fiznat]

Provided that my patient had a good blood pressure and is mentating well and doesn't appear to be hemodynamically comprimised, I still think I'd hold off before jumping to any kind of medication for this patient.

lol yea youre right Shane, but its more fun to talk about meds isnt it? haha. Fluid bolus and O2... how boring is that?! lol

And just for something to think about Fiz, don't forget about Procanimide since it works on both the atrial and ventricular rythems. We don't carry amiodarone in the city yet even though we have it as an option in our protocol. There's only certrain services that have it that we cover for.

Yeahh I never think about Procanimide, even though I guess I should since our service for some reason still carries it. Its not included at all in the new ACLS, and medic class has pretty much all but completely disregarded the med since. Do the protocols specifically call for it, or do they just say "follow AHA guidelines?"

Wonder when we're actually gonna get Amio for all the trucks. I know of only 1 med bag that has it, and even then it only has 150mg which is just the single 10 minute dose. :roll: Guess theres a lot of stuff we "should" have, yet dont.

[medic001918]

Procanimide isn't used frequently, but we do have a few people who have used it. And our protocol does have it listed for wide complex tachycardia's. Our protocols tend to be rather generous and allow us quite a few options as opposed to just an "if this than that" scenario. Amiodarone is in the protocol as well, and a large reason why don't have it is financial since as far as I know the drug is rather expensive. Windsor has it and Bloomfield I believe has it (it's been a while since I've been up there), New Britain has it and a few others.

Shane

NREMT-P

[firefighter523]

I am going to put this thread to bed, it IS DEFINATELY v-tach. Look at the QRS complexes in I and AVF, they are both negative, which indicates extreme right axis deviation. That is the ONLY way you can TRULY diagnose VT. Pending on BP, either Lido, or Cardiovert.

[chbare]

With the information given, I will have to go with ventricular tachycardia on this strip. I agree that the ECG characteristics are consistent with right shoulder deviation and this further solidifies my belief that this is ventricular tachycardia unless proven otherwise. Have the pads handy in the event I need to cardiovert.

Take care,

chbare.

[EMS49393]

A slow V-tach. ERAD with a positive V-1. Treat the patient, not the monitor. A very conscious person would greatly mind being electrocuted.

[aussie_rn]

I'm going with a bundle branch block rather than VT, BBB's always hide what is actually going on too.....

[Thunderchild145]

A-Fib is always irregular. A-Flutter however can be regular.

With this one, I think I'd go with what has already been said. V-Tach until I can prove it isn't V-Tach. ST with BBB? I don't see any P waves. They could be hidden in the T wave, but I just don't see them so I still think VT. A-fib with BBB? Again A-Fib has to be irregular. Ventricular Pacemaker? Well I guess it depends what type of monitor you have. I know on ours, it -will not- display pacer spikes. Instead it places a triangle on the strip whenever it detects one, but you'd have to have a printout of your 4 lead to find out. (It won't print the triangles on the 12 lead.) and that's with our Physiocontrol Lifepak 12. Still, I gotta call this V-tach. As before it's slow, but I still think V-tach.

[nussy]

By my opinion, it's an atrial rhythm with an aberrant conduction.

The patient is doing rather swell clinically and by his vitals + the ECG is missing concordance (which usually points V.tach).

You can treat it as WCT of unknown origin, and you'll be doing the right thing.

Though the patient isn't demonstrating any life threatening situation, administering O2, starting an IV line, and transporting the patient to the hospital, monitored, and not giving any medication is also legitimate, yet I would give him to chow an aspirin 300 mg any way.

Treat the patient not the monitor, the monitor is impressive, the patient a bit less.