Are you confident its VT? Could it be SVT with a r or l BBB?

[8jimi8]

Just took a class yesterday called "Essentials of Cardiac Monitoring"
first i must say EXCELLENT materials.

Before I post any strips up I wanted to see how people feel, in their diagnosis of SVT w/ RBBB or LBBB vs true VT.

Post up your opinions and I'll scan a few of the practice strips in. Or better yet, You all can post up some of your strips and we'll all play. NOW THEN...

we are only talking about SVT vs VT. If you wanna play with other strips there is a thread for that, (or start your own!)

 

[socalmedic]

I am game. lets do this.

 

[firecoins]

lets see some strips.

 

[8jimi8]

ok i'll bust out the book out give me a few mins

 

[8jimi8]

ok heres the a couple of slides


Morphology

Example

ok guys... sorry so big. hehe..

 

[medic417]

For a quick reference page print out page 37 of Bob Page 12 lead course hand out. Here it is from his site.

http://www.multileadmedics.com/documents/MLM2005Master.pdf

 

[TomB]

God save us from using QRS morphology to differentiate VT from SVT with aberrancy! This is how well intentioned paramedics kill patients with calcium channel blockers. Wide complex rhythms, fast or slow, are ventricular until proven otherwise. QRS morphology can be helpful to rule-in VT, but failure to rule-in VT does not-rule out VT!

Please click on the following links and consider them carefully before using Brugada or Wellens criteria for differential diagnosis of wide complex tachycardias.

Differential diagnosis of wide complex tachycardias

More on wide complex tachycardias

Should you ever give a calcium channel blocker to a wide complex tachycardia?

 

[8jimi8]

God save us from using QRS morphology to differentiate VT from SVT with aberrancy! This is how well intentioned paramedics kill patients with calcium channel blockers. Wide complex rhythms, fast or slow, are ventricular until proven otherwise. QRS morphology can be helpful to rule-in VT, but failure to rule-in VT does not-rule out VT!

Please click on the following links and consider them carefully before using Brugada or Wellens criteria for differential diagnosis of wide complex tachycardias.

Differential diagnosis of wide complex tachycardias

More on wide complex tachycardias

Should you ever give a calcium channel blocker to a wide complex tachycardia?

I only read the first point of the first link. I'm glad i didn't pay $110 for this lady's book and cd!

For dicussion's sake, what further criteria is needed to rule out VT?

 

[medic417]

I only read the first point of the first link. I'm glad i didn't pay $110 for this lady's book and cd!

For dicussion's sake, what further criteria is needed to rule out VT?

You should read those blogs of Toms. He will explain it, the blog is in multiple parts. I send my students to Tom's blog. You combine the knowledge of multiple people and develop great Paramedics. As Tom mentioned to many try and use even what I posted without full understanding thus mistakes are made.

 

[Smash]

God save us from using QRS morphology to differentiate VT from SVT with aberrancy! This is how well intentioned paramedics kill patients with calcium channel blockers. Wide complex rhythms, fast or slow, are ventricular until proven otherwise. QRS morphology can be helpful to rule-in VT, but failure to rule-in VT does not-rule out VT!

Please click on the following links and consider them carefully before using Brugada or Wellens criteria for differential diagnosis of wide complex tachycardias.

Differential diagnosis of wide complex tachycardias

More on wide complex tachycardias



+eleventybillion: if it's wide and I feel compelled to treat it, it's ventricular.

And plus eleventybillion and 1 for Tom's blog (and Dr Smiths): they have been more use to me than dozens of textbooks ever have. Cheers Tom!

 

[8jimi8]

i'm glad i started this thread, i'm gonna learn alot more, i can feel it!

 

[CAOX3]

No to hijack your thread but I have a quick question, when SVT is corrected through ablation will that be distinguishable with a 12 lead?

Maybe that didnt come out right, will you be able to tell an ablation has taken place on the 12 lead or would this be something that would need to be compared to the persons pre ablation 12 lead?

 

[TomB]

It depends on whether or not the baseline condition caused ECG changes and whether or not the ablation removed them. For example, the disappearance of delta waves after successful ablation of an accessory pathway. Ideally, the absence of paroxysmal tachycardias would be the hallmark of successful ablation. We had a patient on the stepdown unit many years ago with chronic AF refractory to rate control medications. Her baseline heart rate was 200 at the time of the procedure. The EP ablated the AV node inducing 3AVB and implanted a pacemaker. She came out with a heart rate of 60. My sister's boyfriend had two procedures for paroxysmal atrial flutter. Not many EPs are qualified to perform the procedure because the catheter has to cross the intreratrial septum. Apparently they have to create scar tissue with radio frequency waves around the pulmonary veins. They even used some kind of "star trek" technology where massive magnets guided the catheter inside his heart controlled by a physician using a mouse on the computer. Electrophysiology is still a relatively young field but it's amazing what they've been able to accomplish so far.