Question about a rhythm

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awhiting

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I work for a bls volunteer FD. We ran a call the other day and I saw an "odd" rhythm when the medics hooked up the pt. Here's what happened:

pt was drinking rum and took 6 ambien. bp was 140/72, HR was around 60. He was pretty out of it lying supine on the kitchen floor... but was able to talk to us just fine for the most part and was able to walk out if the house down some stairs (w/ assistance) to the medics gurney.

When the medics hooked him up to the EKG i noticed that everything looked sinus for the most part but everyonce in awhile pt would have a run of qrs complex's that were missing p waves.

Just curious if this is a possible side effect of too much ambien or what....or if anyone has seen anything like it before.

Wish I had a pic of the strip....but I don't :)

Thanks

Aaron
 
Without being able to see the strip, it is hard to say for sure. If I had to guess, it sounds like PVCs, which can be caused by lots of different things.
 
Epi-do said:
Without being able to see the strip, it is hard to say for sure. If I had to guess, it sounds like PVCs, which can be caused by lots of different things.
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I don't think it was PVCs. The QRS complex was identical to the ones that had the p wave in front. I was thinking some kind of junctional..... but I don't know.... All my experience is med school practice strips:blush:
 
PJCs then maybe? Do you have any sample strips that look similar?
 
I don't have any samples.... but picture a normal sinus rhythm.... going anlong just fine.... then here and there there are runs of these QRS's with no p waves in front....same morphology as the rest of them.
 
sorry but without seeing the strip, we're diagnosing in the blind.
 
Was there any kind of pause/delay when these beats followed the normal QRS, or were the R-R intervals consistent the entire time?

-rye
 
It is very hard to give you an accurate answer without seeing the rhythm. Cardiology is sometimes tricky and un-answerable even when you have a rhythm sheet right in front of you.

Take care,
 
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tydek07 said:
It is very hard to give you an accurate answer without seeing the rhythm. Cardiology is sometimes tricky and un-answerable even when you have a rhythm sheet right in front of you.

Take care,
Click to expand...

ask 5 different cardiologist what a rhythm is and you'll get 5 different answers :P

like the others said, can't really tell what it is with out the actual strip, sounds like he was going into some sort of junctional rhythm, which can happen with some overdoses, but not sure if it happens with ambien
 
Sounds like PJCs only going off the normal QRS minus the P-waves. Anything could be possible with this type of drug interaction that affects the CNS.
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