the 100% directionless thread

[E tank]

So then it's the fact our machines aren't precise enough or the mechanical/electrical activity of the heart is just basically tripping over itself?

Ultimately, it doesn't matter what to call the actual regular ventricular or supra ventricular rhythm. What matters is what to do about the symptoms, if any, it creates. If the problem has to be fixed in the electrophysiology lab, there is the capability to look at leads you've never heard of at monitor sweep rates that allow for precise determination of where the problem is coming from.

 

[DragonClaw]

Ultimately, it doesn't matter what to call the actual regular ventricular or supra ventricular rhythm. What matters is what to do about the symptoms, if any, it creates. If the problem has to be fixed in the electrophysiology lab, there is the capability to look at leads you've never heard of at monitor sweep rates that allow for precise determination of where the problem is coming from.

Y'all keep saying to treat the symptoms but how can that be true even most of the time. If an abnormal rhythm might put more stress on the heart, SA node, maybe there's a lower EF that they're compensating for right now, etc.

But because nothing hurts, medically we do nothing?

Or I suppose you just mean in our specific field if prehospital medicine. After all, there's not a whole lot we can do for things like that, compared to like a cardiac surgeon or otherwise more learned staff with better equipment and procedures.

I don't have enough experience to know how likely someone is to be in, say, VFib and say "I'm fine" vs fallen over and saying it hurts or something else.

 

[E tank]

Y'all keep saying to treat the symptoms but how can that be true even most of the time. If an abnormal rhythm might put more stress on the heart, SA node, maybe there's a lower EF that they're compensating for right now, etc.

But because nothing hurts, medically we do nothing?

Didn't say that....adensosine v. DCCV ,inopressor v. volume...or do nothing....or do something else...just depends. But, yes, fast ventricular rates don't need to be named to be treated. Neither do slow ones for that matter.

As there are exceptions to every rule, you ought to be able to name high rate narrow complex ventricular rhythms if you've got CCB's in your protocols.

 

[DragonClaw]

Didn't say that....adensosine v. DCCV ,inopressor v. volume...or do nothing....or do something else...just depends. But, yes, fast ventricular rates don't need to be named to be treated. Neither do slow ones for that matter.

As there are exceptions to every rule, you ought to be able to name high rate narrow complex ventricular rhythms if you've got CCB's in your protocols.

I don't even know what a high rate narrow complex is.

I'm guessing it's referring to the QRS complex combined with tachycardia. But as to what part of the QRS? No idea. I'll look into it

Also have no idea what a CCB is.

 

[NomadicMedic]

Y'all keep saying to treat the symptoms but how can that be true even most of the time. If an abnormal rhythm might put more stress on the heart, SA node, maybe there's a lower EF that they're compensating for right now, etc.

But because nothing hurts, medically we do nothing?

Or I suppose you just mean in our specific field if prehospital medicine. After all, there's not a whole lot we can do for things like that, compared to like a cardiac surgeon or otherwise more learned staff with better equipment and procedures.

I don't have enough experience to know how likely someone is to be in, say, VFib and say "I'm fine" vs fallen over and saying it hurts or something else.

so, nobody in VF is saying “I’m fine”. Ever.

you have to identify the problems as they relate to the presentation.

So, if you have a patient with a Brady rhythm of 40, but they have appropriate mentation, good blood pressure and no complaints, I’ll do next to nothing, except maybe build myself a safety net of a line in case something hits the fan.

You may have a patient with a rate of 40 that is poorly perfused, diaphoretic, vomiting and altered. She’ll get paced and maybe get atropine or a pressor.

You have to treat the patient. The monitor is just there to give you more data to help determine the treatment pathway.

and CCBs are calcium channel blockers, like Cardizem.

 

[NomadicMedic]

When we look at tachycardia, you have criteria to determine what and where it’s coming from.

Is it narrow or wide? Is it regular or irregular?

In a simple world, just those 4 choices alone will give you 4 distinctly different treatment pathways.

Until you have a good working knowledge of interpretation of ECGs, all this info is just gibberish. You need to know the vocabulary (rhythms) before you can can speak the language (treatment).

 

[DragonClaw]

"Now for something completely different"

Unlikely scenario. Sounds ridiculous. But humor me if you will.

If you had a severely bradycardic and symptomatic pt but for some reason had no plain atropine, would you call medical control to give them a duo dote if you had one?

Or could you just start compressions?

Would you ever use a medication in that much of an off label use?

Would pralidoxime chloride have a negative effect if there's no nerve agent action?

 

[StCEMT]

Mmm pronghorn. Wyoming?

Yup. Gonna take a week off and head out there.

 

[StCEMT]

"Now for something completely different"

Unlikely scenario. Sounds ridiculous. But humor me if you will.

If you had a severely bradycardic and symptomatic pt but for some reason had no plain atropine, would you call medical control to give them a duo dote if you had one?

Or could you just start compressions?

Would you ever use a medication in that much of an off label use?

Would pralidoxime chloride have a negative effect if there's no nerve agent action?

If they're symptomatic (not ACLS symptomatic), then I'm putting pads on and pacing them. The other alternative for me would be an epi drip.

 

[DragonClaw]

Yup. Gonna take a week off and head out there.

Go get me, cowboy

 

[NomadicMedic]

"Now for something completely different"

Unlikely scenario. Sounds ridiculous. But humor me if you will.

If you had a severely bradycardic and symptomatic pt but for some reason had no plain atropine, would you call medical control to give them a duo dote if you had one?

Or could you just start compressions?

Would you ever use a medication in that much of an off label use?

Would pralidoxime chloride have a negative effect if there's no nerve agent action?

No. 2Pam is not indicated.

The next option is pacing.

 

[Seirende]

so, nobody in VF is saying “I’m fine”. Ever.

I don't think anyone in v-fib is saying anything at all

 

[NomadicMedic]

Silly question... I’m 5 courses away from finishing my BS. I‘ve earned an AA in the meantime, just by completing the requirements. Is it worth putting the AA as a post nominal or should I just wait til the BS?

 

[PotatoMedic]

I've never put my aas down, but I don't see why you couldn't.

 

[VentMonkey]

Happy Mother’s Day to all of the mom’s on here, and in general. I work today, so we did ours yesterday mostly.

Made the missus some breakfast before work this morning, that was nice. We did a Zoom with the mamas in our familia also; also nice.

As an aside, I’m probably a dozen or so RSI’s in for the year—it’s not even Summer yet, eesh.

I’m also about ready for my safety nap, stay safe all.

 

[DragonClaw]

Happy Mother’s Day to all of the mom’s on here, and in general. I work today, so we did ours yesterday mostly.

Made the missus some breakfast before work this morning, that was nice. We did a Zoom with the mamas in our familia also; also nice.

As an aside, I’m probably a dozen or so RSI’s in for the year—it’s not even Summer yet, eesh.

I’m also about ready for my safety nap, stay safe all.

Apparently fire department isn't incubating literally anyone because of the Rona. They're using an igel if needed. Thoughts on this?

 

[NomadicMedic]

I've never put my aas down, but I don't see why you couldn't.

Seems silly...I guess I'll just wait

 

[DesertMedic66]

Apparently fire department isn't incubating literally anyone because of the Rona. They're using an igel if needed. Thoughts on this?

A lot of agencies have been switching to this process. Some are not intubating and others are not doing CPAP/BPAP while others are not doing either.

My flight service is still doing everything which is what I prefer.

 

[CALEMT]

Apparently fire department isn't incubating literally anyone because of the Rona. They're using an igel if needed. Thoughts on this?

Yeah. I’d be concerned if a fire department was incubating people.

 

[DragonClaw]

Yeah. I’d be concerned if a fire department was incubating people.

FD runs 911. They have medics