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ECG Analysis and Patient Management

Discussion in 'Scenarios' started by nakor, Oct 7, 2017.

  1. nakor

    nakor Forum Probie

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    Call to: 76 yr old male lying in bed. Pt feeling heart is jumping out of his chest and describes his heart feels like it is all over the place. No current chest pain but states something isnt right and every now and then he cant catch his breath. Denies nausea and has no other pain.
    PMHx: unknown but regular blood tests
    Current meds: Aspirin, Warfarin, Digoxin

    [​IMG]
    https://imgur.com/a/n6ELC

    Im learning my ECG rhythms and was hoping to get some help with this example, im thinking SVT or Sinus arrhythmia but have no idea what my treatment would be? Done a bit of research am i looking at amiodarone and magnesium sulphate?
     
  2. StCEMT

    StCEMT Forum Deputy Chief

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    Your picture isn't showing up for me.
     
  3. nakor

    nakor Forum Probie

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    Sorry just provided the link is that working?
     
  4. StCEMT

    StCEMT Forum Deputy Chief

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    It's neither of those rhythms. Break down the basic rules of determining a rhythm and lay them out for us.
     
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  5. VentMonkey

    VentMonkey Crackpot Premium Member

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    This^^^. Another hint would be it's the single most common arrhythmia we see. Not to mention your first paragraph gave it away even before your rhythm strip was available.
     
  6. nakor

    nakor Forum Probie

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    Ok so P wave is the first short upward movement of the ECG and it indicates that the atria are contracting

    The QRS complex is next normally beginning with a downward bit with the first Q is going upwards and a peak which is the R then a downwards S wave. The QRS complex is the ventricles depolarization and contraction.

    The PR interval is the transit time for the electrical signal from the sinus node to the ventricles

    T wave is normally upwards wave representing ventricular repolarization

    In this example we have no P wave before the QRS and theres a T wave after it
     
  7. nakor

    nakor Forum Probie

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    Im looking for a good online source to learn from the book we have been given is really limited.
     
  8. VentMonkey

    VentMonkey Crackpot Premium Member

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    Right, so you're way overthinking this one. Treat the patient from the monitor, i.e., rhythm strip presented + scenario and complaint(s).

    What does the PMH tell you about the patients complaint and current ECG tracing?
     
  9. nakor

    nakor Forum Probie

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    From his meds i know he has heart issues and Digoxin is used to control atrial fibrillation and atrial flutter. And from lookin at arial fibrillation examples of ECG tracings they look similar to this one.
     
    VentMonkey and StCEMT like this.
  10. StCEMT

    StCEMT Forum Deputy Chief

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    Edit because you answered correctly as I posted
     
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  11. VentMonkey

    VentMonkey Crackpot Premium Member

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  12. nakor

    nakor Forum Probie

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    VentMonkey likes this.
  13. nakor

    nakor Forum Probie

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    Trying to find management guidelines the links for management in https://lifeinthefastlane.com/ecg-library/atrial-fibrillation/ touch on self management and mangement of risk factors. Im only a first year student so im trying to get a basic view, like give this to manage this and this to manage that if you know what i mean.
     
  14. nakor

    nakor Forum Probie

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    Theres lots of information on long term management... Found some info saying IV heparin and Warfarin to prevent thromboembolism and then transport
     
  15. StCEMT

    StCEMT Forum Deputy Chief

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    I would suggest focusing on learning to identify the rhythms before you learn managment. You have to know what you're treating to treat it.
     
  16. nakor

    nakor Forum Probie

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    I have this OCD systematic approach to everything I normally write up a few pages of epidemiology/ aetiology/ pathophysiology then management of condition and move onto the next haha
     
  17. Gurby

    Gurby Forum Asst. Chief

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    [​IMG]
     
  18. Chris07

    Chris07 Competent in Incompetence

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    Okay I'll bite. Why would you put someone with A.Fib on an anticoagulant? For bonus points....why are they on Digoxin to manage their (presumably) atrial fibrillation and/or heart failure?
     
  19. phideux

    phideux Forum Captain

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    Get Dubins "Rapid interpretation" of EKGs, it's like EKGs for dummies. Great book.
     

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