the 100% directionless thread

Clare said:
Attention Intensive Care Paramedic whom with I disagree

This is not AF; it looks some sort of irregular tachydysrhythmia with no fibrillatory waves and what looks like ST depression (although I hear we should not look at the ST segment on a rhythm strip) ... in fact we shouldn't really be acquiring rhythm strips any more, if the patient is "sick" enough to get an ECG, they should get a 12 lead ECG

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Looks like a some sort of irregular junctional rhythm to me. Or maybe it has the ever elusive PJCs. Definitely wouldn't call that A-fib.
 
Aprz said:
Why not?
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Well like Clare, I am not seeing any fibrillation. When I think afib I think an excessive amount of p waves; not an absence.

To me, the narrowness of the qrs complex is the only thing that might indicate electrical origin above the atria. There are also some waves that look like inverted p waves.

I'm not an ecg expert by any means. I could very well be wrong.
 
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Never really looked at the heli pad at one of our hospitals. Big enough for one helicopter. It is surrounded by a pond with mini water features that have to be turned off when HEMS is landing.

I don't even want to know how much that helipad alone costs.
 
firefite said:
Never really looked at the heli pad at one of our hospitals. Big enough for one helicopter. It is surrounded by a pond with mini water features that have to be turned off when HEMS is landing.

I don't even want to know how much that helipad alone costs.
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Donde?


Edit: I'm still partial to Hoag Memorial Medical Center's helipad setup. It's built above the ambulance bay, which means that the ambulance bay is protected from the elements.

https://maps.google.com/maps?q=hoag...memorial+medical+center&radius=15000&t=h&z=20
 
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Got a new band I like, Aiden. Saw them friday night with black veil brides in San Francisco. Awesome music.
 
Aprz said:
I'd call it atrial fibrillation with rapid ventricular response.

It's fast and irregularly irregular. There are no visible p-waves, and QRS complexes are narrow.

My differential for an irregularly irregular rhythm is: atrial fibrillation, multifocal atrial tachycardia, wandering atrial pacemaker, and atrial flutter with variable block. By propability alone, atrial fibrillation is the second most common supraventricular trachycardia (sinus tachycardia is first).

There is a clear gap between some complexes where I would expect a p-wave, but I cannot see any p-wave or flutter waves.

Fibrillation waves in atrial fibrillation can be like ventricular fibrillation, it can be coarse or fine.

ST depression is common in tachycardias.
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Agree on all points. The base line is not always an obvious coarse fibrillation but can also get fairly fine and almost non existent. There have been times if a rhythm was a little more regular I would swear it was junctional rhythm but was confirmed to be A fib by EP study.

My Ddx for the rhythm above would be A fib vs junctional arrhythmia. But I would certainly not rule out a fib.
 
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exodus said:
Mercy landed there a few weeks ago!
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Reach landed there today. Security tried to block the ambulance entrance with their trucks. They weren't too happy when I made them move.

And since when did dispatch start saying "medic 108 be advised, the patient has been given aspirin"?
 
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Chase said:
I had a patient last night with facial burns from smoking a cigarette with his oxygen on. It looked like he had on clown make up, red all around the mouth and nose. Apparently this is not the first time this has happened.
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Oh hell no. It's actually pretty amazing how much this occurs. Well, for us, nothing is surprising...but anyway....
One would never know this unless they were in EMS, an ED, Burn Unit, etc.

I try to explain to people(outside of the aforementioned places) that, yes, this actually happens to people, and that, yes, people smoke cigarettes with flammable oxygen attached to their face.

It's no joke, either. The last one I had was RSI'd in the ED, and sent up to the unit before we even had a clean sheet on the stretcher.
 
Just got back to the hotel after going to see BonJovi. He totally rocked the house (and he's pretty easy on the eyes, too)!
 
Clare said:
You could always get married at the court house for like $20 if you're that keen, one of my friends and her husband did that cos they were broke .... I guess its being together that counts not the amount of money you spend, but I am the first person to admit I am no expert on the subject?
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Speaking of saving money, I just found out they are discontinuing my wedding dress. The colors I want aren't being produced anymore, so I'm changing my colors... and getting the dress for $200 less.
 
Trashtruck said:
I try to explain to people(outside of the aforementioned places) that, yes, this actually happens to people, and that, yes, people smoke cigarettes with flammable oxygen attached to their face.
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...oxygen isn't flammable. Proof: The air isn't on fire.
 
katgrl2003 said:
Speaking of saving money, I just found out they are discontinuing my wedding dress. The colors I want aren't being produced anymore, so I'm changing my colors... and getting the dress for $200 less.
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The next Geico commercial right there. :rofl:
 
I don't get the point of detox or colon cleanse diets. If you want to detox (not that there's any proven point outside of prep for procedures), you don't need a special diet and a week. You need a day and a nice large jug of GoLytly. I guess some magical beads might help too.
 
Aprz said:
Fibrillation waves in atrial fibrillation can be like ventricular fibrillation, it can be coarse or fine.

ST depression is common in tachycardias.
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I knew VF could be fine or coarse but didn't extrapolate that to AF; guess you are right; the answer I got was that "if its irregularly irregular then it is AF or MAT" and that rhythm strip clearly is not MAT ...

Aidey said:
That is a total fallacy. Checking what rhythm someone is in doesn't automatically make them sick enough to need a 12 lead.
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I am initially inclined to agree with you to a point, and a year or so ago I would of, but then I thought it about some more; ED will initially get a 12 lead then monitor on a single lead if the patient is going to a monitored bed.

If I am interested in what rhythm the patient is in then its obviously important enough for me to acquire a 12 lead ECG, or so I think, it takes about ten seconds longer and provides far more useful information than a rhythm strip.

If I grab a quick pulse and its fast or slow and the patient is not compromised and has no cardiac symptoms or signs then I do not actually care anything more than that. Somebody who is alert and just has happens to be bradycardic does not need a 12 lead ECG or even a rhythm strip but somebody who "feels funny" with no obvious cause or has tachycardia that does not resolve with time or reassuarance etc does require a 12 lead ECG

Here is what we are taught

Acquire a 12 lead ECG when:

  • the patient has pain that may be cardiac in nature
  • you suspect a cardiac problem (including dysrhythmia)
  • the patient has collapsed and there is no obvious cause
  • the patient has shock and there is no obvious cause.

Do not to acquire a 12 lead ECG when:
  • the patient’s condition is life threatening or time critical and acquiring a 12 lead ECG would significantly delay treatment or transport.

Note: judgement should be used if the patient has ROSC post cardiac arrest. A 12 lead ECG should be acquired provided it does not interfere with ensuring a good airway, effective ventilation and a good circulation, especially if the result may change the hospital the patient is transported to.

Epi-do said:
Just got back to the hotel after going to see BonJovi. He totally rocked the house (and he's pretty easy on the eyes, too)!
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So um, would you be living on a prayer that Bon Jovi comes back to your hotel room? LOL ... that was terrible I know, but thats the only Bon Jovi song I know because it kept looping on the house music at this bar I was at with some friends one night :P

katgrl2003 said:
Speaking of saving money, I just found out they are discontinuing my wedding dress. The colors I want aren't being produced anymore, so I'm changing my colors... and getting the dress for $200 less.
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They no longer make white? :wacko:

JPINFV said:
...oxygen isn't flammable. Proof: The air isn't on fire.
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This. Is. Amazing .... never mind about that whole 100% oxygen vs 21% thing, there is conclusive proof right there!
 
Clare said:
This. Is. Amazing .... never mind about that whole 100% oxygen vs 21% thing, there is conclusive proof right there!
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Not sure if serious.....

Even 100% oxygen is not flammable
 
Chase said:
Agree on all points. The base line is not always an obvious coarse fibrillation but can also get fairly fine and almost non existent. There have been times if a rhythm was a little more regular I would swear it was junctional rhythm but was confirmed to be A fib by EP study.

My Ddx for the rhythm above would be A fib vs junctional arrhythmia. But I would certainly not rule out a fib.
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What about ruling out fine vfib/asystole?
 
Section 12 thread = post count ++
 
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