Ok Ghettomedics what do you think?

[bakerotfd]

Agreed with the SVT DX. There are P waves buried in there.

I am not sure what I'd do for this guy. Probably go with Adenosine first, given the fact he is still mentating well, no pulmonary edema, diapohoresis, only borderline hypotensive, or anything other than the CP complaint. Any sign of shitting himself would get Cardioverted ASAP.

I agree. It apperas to be a narrow complex tach. with good distal pusles. If the pressure is "stable" I would start with adenosine and go from there. In consult with Med. control I may head into Lopressor or cardiversion dependent on the CP and other factors.

[PSYCtest040]

First of all this wasn't my patient. The Medic that transported handed me the strips, gave me a brief history and treatments and left for vacation. He did tell me he tried adenosine x2 with no changes and 150 of amio with no change. He was on the phone with med control as they were pulling into the hospital parking lot. What I heard from the basic tech was the patient started decompensating in the ED and was successfully cardioverted.

I do agree its a supraventricular rhythm but with vagle and adenosine not showing the underlying rhythm I cant say if its a pre excitation, afib with rvror, as out in the woods it may be, a flutter. I wish the Medic gave me more info but he was in a rush to get home and make his flight.

[wvditchdoc]

First of all this wasn't my patient. The Medic that transported handed me the strips, gave me a brief history and treatments and left for vacation. He did tell me he tried adenosine x2 with no changes and 150 of amio with no change. He was on the phone with med control as they were pulling into the hospital parking lot. What I heard from the basic tech was the patient started decompensating in the ED and was successfully cardioverted.

I do agree its a supraventricular rhythm but with vagle and adenosine not showing the underlying rhythm I cant say if its a pre excitation, afib with rvror, as out in the woods it may be, a flutter. I wish the Medic gave me more info but he was in a rush to get home and make his flight.

Just for my own morbid curiosity, wonder why he didn't go ahead with the third dose of Adenosine? I have had several that took until the third dose to break.

I don't think, personally, that it is Flutter or Fib. Everything marches out too perfectly. As for the shortened P-R someone mentioned before, it is very difficult with something that fast to tell if it is shortened or the heart is just basically firing the atria and ventricles almost simultaneously. It also looks like there is some aberrant conduction? The QRS is a little wider than is typical with an SVT.

Anyway, cool strip.

[PSYCtest040]

Just for my own morbid curiosity, wonder why he didn't go ahead with the third dose of Adenosine? I have had several that took until the third dose to break.

I don't think, personally, that it is Flutter or Fib. Everything marches out too perfectly. As for the shortened P-R someone mentioned before, it is very difficult with something that fast to tell if it is shortened or the heart is just basically firing the atria and ventricles almost simultaneously. It also looks like there is some aberrant conduction? The QRS is a little wider than is typical with an SVT.

Anyway, cool strip.

Basically it all comes down to Protocol. Our Protocol is for on line orders for undifferentiated wide complex tachycardia. First dose 6mg rapid IVP followed by 10cc NS flush and second dose two minutes later 12mg rapid IVP with 10cc NS flush. Some docs may order a third and some may not.

[wvditchdoc]

Basically it all comes down to Protocol. Our Protocol is for on line orders for undifferentiated wide complex tachycardia. First dose 6mg rapid IVP followed by 10cc NS flush and second dose two minutes later 12mg rapid IVP with 10cc NS flush. Some docs may order a third and some may not.

Fair enough, just wondering.