the 100% directionless thread

Yea it wasn't irregular. The monitor said vtach. And just from what ive seen it looked like it. And there was some elevation. So like I said, I'm not sure what was going on.
 
Anjel1030 said:
Yea it wasn't irregular. The monitor said vtach. And just from what ive seen it looked like it. And there was some elevation. So like I said, I'm not sure what was going on.
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Hmm which monitor are you using that will interpret VT?
 
Phillips
 
Anjel1030 said:
Phillips
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I am sure Phillip wants his multi thousand dollar monitor back :D

We have some here, never used,one and now were going back to LPs

There are a bunch of MRx information on our moodle ima go watch it, I'm curious now lol
 
Sasha said:
I'm so hungry.

And all I have in the house is cupcakes.

24 of them to be exact.
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So... what's the problem? :ph34r:
 
I hate to post informational stuff. I was gonna send you a private message about heart rates and COX-2 inhibitors when you talked about the kid getting Tylenol, typed it up a couple of times, and decided not to send it. I rather spam. Anyone else does that before they send a message or post something?
Anjel1030 said:
The doctor was arguing that it was Afib and not Vtach. But there wasnt any p waves so idk.
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I think it's unlikely you'll see a p-wave in either rhythm. Atrial fibrillation has a bunch of parasystolic beats at the atrium creating a bunch of jagged lines in between the QRS complexes (classically a fast irregularly irregular rhythm, narrow complexes, no visible p-wave). Ventricular tachycardia ectopic beat starts at one of the ventricles, but I think it's possible to see retrograde p-waves after the QRS complexes (fast, wide QRS complexes). I'm pretty much reiterating what R99 said short of I don't think nobody caught what you said about the p-waves.

I imagine the two rhythms would be hard to mix up UNLESS the doctor was saying it's atrial fibrillation with an accessory pathway like with Wolff-Parkinson-White syndrome, which is commonly discussed (on the ACLS cards and booklets, they'll say "SVT with aberrancy" and/or "afib + WPW", here is an example picture - look to the right under irregular wide).

There are a couple of criteria to help favor one rhythm over the other e.g. if lead aVR is positive or there is an initial R-wave, more likely vtach (cause it's starting at the ventricles and going up towards the atriums), if the mean QRS vector goes towards no man land (around -90 degrees to -180 degrees, could be a wider range, not trying to give you exact numbers), likely vtach (same reasons as aVR explanation), if you can spot delta waves (curved R-wave), favors afib + WPW (suggests bundle of Kent's exist), SVT with aberrancy is usually much faster than vtach (not exact numbers HR >250 for afib with WPW vs. HR 120-250 for vtach... remember when they teach you in EMT school or in an EKG book SA/atria area 60-100 or 60-80, AV/junctional area 40-60, and ventricles 20-40, or something like that? Usually the higher up the ectopic beat is, the faster.... (in Dubin Dale's book, he teaches it at the beginning to help you at least guess what rhythm it is using rate alone), changing morphology suggest afib + WPW (changing between different pathways). These are things that should make you suspicious of which rhythm it is, but the general rule is "Treat wide fast rhythm as vtach until proven otherwise" like TomB always says on here and at his website ems12lead.com.

Per the ACLS standards I know and what you can see in that link I provided earlier, and they are probably the same as the new standards (pretty much they put emphasis on what to do when you achieve ROSC, removed atropine, emphasis on chest compressions, and changed to CAB for BLS), the treatment is similar. If the patient is hemodynamically unstable, cardioversion. If they are stable, consider sedation before cardioversion. Consider antiarrhythmics like amiodarone. For the SVT with aberrancy, drugs like adenonsine are contraindicated (don't want to make the accessory pathway e.g. bundle of Kent the dominant pathway).
 
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R99 said:
A patient with VF is probably going to be more sick than somebody in AF as AF is generally well tolerated
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Umm...people in VF are dead...you know the whole lack of perfusion issue and all :)

But people walk around in afib all day every day without problems ;)

Like aprz said delta waves in wpw could make distinguishing vs VT a bit more difficult. Why not do a 12-lead and find out which it is? Pt is "stable" and relatively asymptomatic so there's no reason to cardiovert him. Id play with my MRx and find out exactly what it is.
 
bigbaldguy said:
In all seriousness I'm glad to hear he's out of surgery. I suspect he's not the type to lay around in a hospital for long. In fact you better check on him he may be signing his own discharged papers while you read this.
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He threatened to sign out AMA when they put him back on a liquid diet after surgery, but I sneaked in a coke and he was happy again.

Actually, he is talking about making a Black Forest Torte cake for the nurses to show how much he appreciated them. See? If you don't give him any reason to yell at you, he can actually be somewhat tolerable.

One nurse in particular got a hug from him because all the other nurses said he wasn't allowed a shower, only a bed bath... she told him she would ignore the fact he took a shower (this was 6 hours after surgery). I think he would have kissed her if I wasn't in the room. Although, there was a very hot nursing student that said she would help with the bed bath, and I'm pretty sure he was about to accept when I told her no.

He was discharged 24 hours ago, and is doing pretty well. He's not in very much pain, but is still on Vicodin. He says hi to everyone and says thank you for all the well wishes.
 
Glad he's doing well, Kat :D
 
Aprz said:
I hate to post informational stuff. I was gonna send you a private message about heart rates and COX-2 inhibitors when you talked about the kid getting Tylenol, typed it up a couple of times, and decided not to send it. I rather spam. Anyone else does that before they send a message or post something?
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Oh Really?
 
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