Axis deviation and the 12 lead

[rhan101277]

I guess it's pretty obvious that I'm not a huge fan of prehospital antiarrhythmics. It seems to me that if a tachydysrhythmia is "significantly compromising" then it should be cardioverted. If it's hemodynamically stable, why are we messing with it? We don't know what we're going to get when we push amiodarone. Maybe the patient will get better. Maybe the patient will get worse. The nana who's having a STEMI needs reperfusion, not amiodarone, IMO.

Tom

Deleted post, its to late tonight and I confused myself.

 

[MrBrown]

I had a Paramedic tell me about a patient he had that was in V-Tach. Pt. was borderline so he opted to cardiovert. Pt. went into arrest immediately upon cardioversion. He questions now whether or not lidocaine first would have suppressed the rhythm and had the patient fair out better. We will never know.
.

That is a rare complication of cardioversion.

For a borderline patient who is still tolerating the rhythm I might hang some amiodarone first, slap on the pads and see how we go; if the amiodarone doesn't work I'd cardiovert

 

[82-Alpha599]

Recent evidence suggests that patients with new (previously undetected) LBBB do not rule in for MI at any higher rate than other patients, unless they also meet Sgarbossa's criteria for AMI in the presence of LBBB. Generally speaking LAFB and LPFB (a diagnosis of exclusion that is extremely rare as an isolated finding) do not distort the ST-segment the way LBBB does. If it's a "new" hemiblock secondary to acute STEMI, ST-elevation will also be present.

Tom

Well I guess my question really is what does a new onset hemiblock (with chest pain) without the presence of ST changes signify?
NSTEMI?
Or is it more often then not nothing other than insignificant conduction ectopy?

 

[TomB]

Well I guess my question really is what does a new onset hemiblock (with chest pain) without the presence of ST changes signify?
NSTEMI?
Or is it more often then not nothing other than insignificant conduction ectopy?

The point seems to be that if a previously undetected conduction abnormality is secondary to acute ischemia it will also be accompanied by an ST-segment abnormality.

So no, I don't think it implies NSTEMI, since patients with "new" LBBB do not "rule in" for AMI at any greater frequency than other patients worked up for chest pain (STEMI or NSTEMI).

Tom

 

[sdadam]

Just a thought to the OP.

There was a day when I said things like this, but I think you should take a little time and check your attitude, you don't have the knowledge or experience yet to tell a good medic from a bad. Being in school and being inundated with new information can make you feel like you know all about paramedicine when in fact, you know just enough to look stupid in front of everyone.

Now, I'm not saying there aren't medics out there who suck, there are plenty, but I'm very wary of paramedic interns who talk about how they are going to be so much better than everyone out there once they get done, and how they know so much more than all these crappy medics, an ounce of experience is often worth a ton of knowledge.

I understand you are blowing off steam because people in the field told you that all the cool things you are learning don't play out in a clinical setting just the way you wanted them to, but the answer is often to learn from experience, and be patient and quiet, rather than deciding you are going to re-invent the wheel of paramedicine as an intern.

Check the attitude, or you are in for a rough ride in clinical and internship.

 

[dmiracco]

For the love, give nitro.

 

[rhan101277]

Just a thought to the OP.

There was a day when I said things like this, but I think you should take a little time and check your attitude, you don't have the knowledge or experience yet to tell a good medic from a bad. Being in school and being inundated with new information can make you feel like you know all about paramedicine when in fact, you know just enough to look stupid in front of everyone.

Now, I'm not saying there aren't medics out there who suck, there are plenty, but I'm very wary of paramedic interns who talk about how they are going to be so much better than everyone out there once they get done, and how they know so much more than all these crappy medics, an ounce of experience is often worth a ton of knowledge.

I understand you are blowing off steam because people in the field told you that all the cool things you are learning don't play out in a clinical setting just the way you wanted them to, but the answer is often to learn from experience, and be patient and quiet, rather than deciding you are going to re-invent the wheel of paramedicine as an intern.

Check the attitude, or you are in for a rough ride in clinical and internship.

My attitude is fine, I didn't mean it to seem like I had an attitude. I have had some great field experiences since this post as well. Some of my preceptors really drill me for info and let me team lead, which is tough but I do my best and then they tell me how I could have done better etc.

Also I never talk to medics like I know everything because I don't. If I think something needs to be done or I wonder why it was not, I use tact to do that.

 

[dmiracco]

Give the nitro