V-Tach or Not?

[Medic26]

Here is a strip from a patient I had yesterday, treated as V-tach but cardiology physician says its not V-Tach but no explanation as to why it isn't either. Whats your opinion? #-o

Ok, I can't seem to make it any biger so, the leads are from top to bottom II, I, III

The rate is 156. The image can be viewed in full size on my myspace page.

[AZCEP]

The image isn't showing up. From the limb leads, you really can't tell anything.

[CBEMT]

I can see the image, it's just small as you said.

And AZ, the look we get from the limb leads is all some of us are going to get.

That said, looks like VT to me. Rate seems too low though, I'll give you that.

[AZCEP]

Having the LP12, you should be able to get the augmented leads to get a better idea of the axis.

The rate of 156 is plenty fast to be VT.

What did you use to treat it?

Can you get the cardiologist to explain why this isn't VT to you? This isn't a cardiologist specific situation. If you don't treat the patient right, he doesn't get a chance to tell you you were wrong.

What's the link to your myspace page?

[chbare]

Was the patient stable? Were you able to obtain a 12 lead? An assessment of the axis would be helpful. (Right shoulder deviation.) In addition, patient history could also help. For example a history of WPW.

Take care,

chbare.

[Medic26]

http://viewmorepics.myspace.com/index.cfm?...imageID=8397320

Patient was stable, treated with lidocaine without success. And the cardiologist was to stuck on himself to talk to some lowly little paramedic and explain it to me. :roll: And I actually didn't think about grabbing a 12 lead until it was to late. This kinda took me by surprise as I was treating this patient for SOB/Pulmonary edema.

[AZCEP]

Apparently, I'm having some of the same image viewing issues you had in posting it.

Is the rhythm regular?

Is there any discernible irregularity with the R-R intervals?

If the cardiologist has ruled out VT, what are some of the other options? There are only a couple that will meander around the 150 beats per minute range.

How old was the patient?

What was the rhythm when it was converted?

[Medic26]

http://f7.yahoofs.com/users/7x86CYdvZhoa/_...p;saveas=strip1

Here I will try another one.

[kkidfall]

Stupid question, but are there P waves? it kind of looks like there are but it's hard to tell. Also if it is, could it possibly be 2:1 AFib with an aberrancy?

[Chief1C]

http://f7.yahoofs.com/users/7x86CYdvZhoa/_...p;saveas=strip1

Here I will try another one.