R on T

[JackTensley]

so i was standing in the Emergency room looking at a monitor when i saw something i've only heard about.

was a young male patient, some left sided chest pain, normal vitals. had 1-3 PVCs a minute. then suddenly on the down slope of his R wave, he had a ventricular contraction, known as R on T. R on T is pretty rare, and when it happens, the patient goes straight into V-Tach or V-Fib, or in his case Torsades. luckily the doc was there to do a precordial thump. pretty crazy. i have a picture of the strip here

pretty crazy huh?

 

[Tincanfireman]

Pretty crazy, indeed; but how about some more information for inquiring minds? Age, PMHx, onset, duration, recent medications (either recreational or prescribed), and eventual outcome (any recurrance?). Even though I'm not a medic, I love stuff like this, if only because it is rare and different from the norm. Quite a first post, too! Welcome to the forum...

 

[JackTensley]

Pretty crazy, indeed; but how about some more information for inquiring minds? Age, PMHx, onset, duration, recent medications (either recreational or prescribed), and eventual outcome (any recurrance?). Even though I'm not a medic, I love stuff like this, if only because it is rare and different from the norm. Quite a first post, too! Welcome to the forum...

sure, this is all from memory so i'll see what i can do
32 y/o male with no PMH, allergies, or medications. the patient walked in to the ER and checked himself in. the doctor was doing an assessment on him (shes a really good doc) when it happened. she did not bring him back witha precordial thump, but they shocked one time with success. i dont even think they cracked the crash cart in there, it happend so fast. i'll have to find all of this stuff out. i'll repost with some more info...i do know it didn't happen again and that he turned out fine. he was just in the right place at the right time.

 

[BossyCow]

So, is there any info on what lead to the event?

 

[natrab]

Very interesting. I've never seen a strip of that either. Strange that he went into torsades. Did he end up getting mag? What did he do to get his system so off balance? Very strange for someone relatively young.

 

[Ridryder911]

Personally, I would work him up for potential "sudden death" syndrome, I am curious why he was at a physician office initially for? As well, a UDS (urine drug screen) should be perfomed to check for meth, crank, cocaine, etc. that can also precipitate such an event.

Lucky guy...

R/r 911

 

[TKO]

neat! Never seen a strip of it either.

 

[MasterIntubator]

Now, I'm a little intrigued here... having seen torsades a few times, as they usually happen with faster rhythms and prolonged QTs.... there are some marks on this ECG that are not so clear. Above the rhythm, are those pace indicator marks? Some recorders pick up the pacemaker spike and mark it either above or below.
I see that one spike might have been real close to the absolute refrac stage ( as the majority of the R on Ts in my care have been from pacemaker failure/lead failure ).

But, something happened at the end of that T.
This stuff is fascinating, I love this stuff!!!

The marks don't follow up with the classic sync mode, and they do speed up once the R on T happens, which is interesting.

I'm gonna dream about this one for a bit.