V-Tach or Not?

[medic001918]

I would prefer it explained but since he didn't armchair it, I'll take a short humble opinion. As far as 12-leads on SOB patients, unless they have cardiac complaints we are not required nor is it even referenced in our protocols. The only time we are required/asked to perform them is chest pain/ACS patients. You can bet your posterior that it won't happen agian.

I respect your opinion but just because someone didn't treat a patient the way you would have treated a patient does not mean they were wrong. I have worked a few different regions/states in several different services, every place puts emphasis on different things but the care is generally the same. Something you find as a major delinquency in your area may be nothing but provider discretion in another, BUT IT DOESN'T make it any more right or wrong.

Not once did I say that you were wrong in your treatment. I've actually stated repeatedly that this should be a learning experience for those who read the thread as well as yourself. And if you really want to get technical, you never posted exactly what was done for this patient. This has been strictly about the EKG other than knowing what the patient's complaint was. I'm glad that you won't let this happen again in your practice. It demonstrates that you've learned from the experience and it will have a positive impact on the patients you might come into contact with in the future. That in itself makes this call worthwhile, up to and including the discussion.

With regard to what's expected of your region, I don't understand why a patient complaining of shortness of breath wouldn't be suspected to possibly have a cardiac etiology, symptom or complaint. How do you determine the need for further cardiac work-up? This is NOT meant as a bash, I'm just looking for insight into how providers in your service come to this determination. A patient in heart failure or having an MI are great examples of someone that may be complaining of a respiratory complaint while their underlying problem is a cardiac in nature. Maybe you are taught some different assessment techniques to use that would help others that read the forum (meant with no sarcasm). I'm all about learning and enjoy learning how other services work. I often pick up things that I can incorporate into my daily practice.

Shane

NREMT-P

[scottymedic]

Scottymedic, why do you think this is ventricular tachycardia? This is not a challenge; however, I am curious to see how you arrive at this conclusion. As stated earlier, right shoulder axis deviation is characteristic for ventricular tachycardia. Upon completing a 3 lead axis assessment, I do not think there is right shoulder deviation. This does not definitively disprove the ventricular tachycardia hypothesis; however, it leads me to question the actual origin of the tachycardia.

Again, I am not trying to bust anybody. I love great conversation and I love to see how people arrive at their conclusions.

Any follow up would be helpful. Any way to obtain a copy of the 12 lead performed at the receiving facility?

Take care,

chbare.

Thank you for posting your qeusting matey I guess initial look at the ecg would make me think it was vtach due to the wide complex and the rate, whilst being slow, is still a tachy none the less. Complexes now that I have had another look, do co incide with the explaination you gave.

AZCEP, hehehe yeah hook me up with any toys you do have

Thanks for that education point Chbare, appreciate it

[chbare]

Not a problem. I love to learn and enjoy looking at how other people think.

Take care,

chbare.

[ohemt648]

I have been watching this thread with great interest! We are currently learning rhythm interpretation in class. We haven't started 12-lead yet, but I can see where it could be a great tool. I love threads that are full of great information such as this one, sometimes I think I learn more on here than in class :? :wink:

Take care and be safe,

648

[Inf]

The reason I asked is this cardiologist took one look at the patient and a 2 second glance at the monitor strip and said "your wrong" and walked out of the room. He didn't have any patient history, vitals or nothing else but he was able to make the determination. I posted this strip to see if I had missed something, wide complex, bizaar, unifocal tachycardia.......yeah maybe I should have done a 12-lead but I didn't have time. I suppose that some of you are perfect but me.....I make mistakes and have oversights on occasion.

You have your Lead II on top, Lead I on middle and Lead III on bottom of this strip, if this is so you have Left Axis Deviation. If it was extreme right axis deviation, it would probably be a VTach. This could also be hyperkalemia. Without a 12Lead you really dont know anything about your patient (other than asystole and VF :wink: )

[scott33]

The reason I asked is this cardiologist took one look at the patient and a 2 second glance at the monitor strip and said "your wrong" and walked out of the room. He didn't have any patient history, vitals or nothing else but he was able to make the determination. I posted this strip to see if I had missed something, wide complex, bizaar, unifocal tachycardia.......yeah maybe I should have done a 12-lead but I didn't have time. I suppose that some of you are perfect but me.....I make mistakes and have oversights on occasion.

In leads I, II, and III you can pretty much rule out VT if you do not have extreme right axis deviation in all leads. That is, all QRSs pointing more downward, and below the isoelectric line rather than upward and above it. VT would be confirmed if lead V1 was upright (had you done a 12-lead). This does not appear to be the case in your lead I (the middle one) so yes, it could be ruled out, to the trained eye in a second or so. Of course the 12-lead would tell for definite.

If you get a chance, go to Bob Page's multi-lead seminar, or buy his book. I thought I knew the basics of EKGs until he blew me out of the water.