benkfd
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Am I seeing R' in V1 -V4?
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I agree it looks like a narrow QRS, but the other criteria you list do not suggest a non-VT diagnosis. AV dissociation is only present about half the time with VT and is often difficult to appreciate. VT can show a normal axis, right axis deviation, or left axis deviation. Negative concordance favors VT, but an absence of concordance does not rule it out. Just clarifying because wide and fast is VT until proven otherwise! That's one of the most important rules of ECG interpretation.
What if it was aberrant SVT though and you gave lidocaine? Won't that make the situation worse if you gave lidocaine to a supraventricular dysrhythmia? Personally I would give amiodarone as the AHA recommends since it is also effective on supraventricular rhythms.
Thanks for the clarification, but I thought VT almost always presents with an extreme right axis deviation? Anyway, good to know. Of course I would always treat wide and fast like VT. I'm very new to advanced 12 lead interpretation like I just tried to do.
What if it was aberrant SVT though and you gave lidocaine? Won't that make the situation worse if you gave lidocaine to a supraventricular dysrhythmia? Personally I would give amiodarone as the AHA recommends since it is also effective on supraventricular rhythms.
What if one incorrectly interprets a rhythm as supraventricular with aberrant conduction and decides to give adenosine when it is in fact of ventricular origin? On first thought I wouldn't think adenosine would make VT any worse since it works on the AV node and in VT the pacemaker is in the ventricles, but evidently I am wrong since it is always a major point to treat wide and fast like VT until proven otherwise.
What about giving adenosine to peds with wide complex tachycardia? In the PALS algorithm they advocate giving a trial of adenosine to apparent VT prior to cardioverion. I suppose aberrantly conducted SVT's are more common in peds than adults?
Venty where are you on this one? Theres been a few stabs but a few to many chickens as well. Come on troops we may have to treat a pt like this one day - somebody obviously had to before. For the guys infering this is a nasty looking rhythm please explain in a bit of detail. Some of us EKG fumblers need some pointers.
Go back to your basics.
Activate Cath Lab, 2 large bore IVs, monitor vitals, ASA, nitro, Lopressor (if applicable) Morphine or Fentanyl, O2 via most appropiate device, and a healthy diesel bolus.
Also, if you draw labs, draw em up.