Twisted Ribbon Torsade de Pointes

[samiam]

How often do you guys encounter this? I am halfway thru Rapid Interpretation of EKG's and had the unique experience of getting to see patients with 1prime AV block, Left axis deviation, STEMI, Torsade de Pointes and asystole all in one night (Friday) and made copies of all but the Asystole and Torsade de Pointes. I am hoping to track down one of the nurses I think made a copy so I can add it to my collection.

 

[8jimi8]

How often do you guys encounter this? I am halfway thru Rapid Interpretation of EKG's and had the unique experience of getting to see patients with 1prime AV block, Left axis deviation, STEMI, Torsade de Pointes and asystole all in one night (Friday) and made copies of all but the Asystole and Torsade de Pointes. I am hoping to track down one of the nurses I think made a copy so I can add it to my collection.

1 year of critical care, 1 year on a cardiac stepdown (probably 30 codes) i've seen it once.

 

[Veneficus]

Officially saw it twice in my whole time.

Once during paramedic clinicals in a cardio unit.

Once working on a rig, call came in from a nursing home as "altered labs." Pt. was unresponsive when we got there.

I suspect it existed in more codes I worked, but usually when people saw VT, it was treated such very quickly.

 

[canisdoo]

We just successfully revived a patient after working him for an hour. He did go in to torsades a few time but you always treat it initally as polymorphic VT. He Responded to the counter-shocks and mag was placed for refractory VT. His QTc was only .448 so one can argue the validity of torsades. This is the second time I have seen this rhythm and first after 30 min of CPR. Amiodarone was used post arrest. Was not administered during the code. I have seen it on a ekg of a patient taking QT prolonging medications. Look at torsades.org and it is actually more common than what is reported with medications precipitating the disorder.

 

[medicmurphy]

Once

I saw Torsades once (confirmed it quickly by putting the LP12 in pacing mode to see the spikes).. It was a 70 ish male who took a 12 inch kitchen knife and stabbed himself between the 2nd and third intercostal space.. His wife had pulled the knife out, he was concious and breathing.. This occurred enroute and needless to say it was fun watching the BLS FF as I started two 14 ga IVS (LR and NS), ekg placement, and rsi'd said patient.. Havent seen it since..

PS.. He was pulseless and responded to one 200J defibrillation.. He made it to the ER alive, but not from the surgery..

 

[TomB]

I would suggest that TdP is encountered far more often than it's recognized.

 

[PHRNJAK]

I have been a critical care nurse for 12 yrs. probably saw torsades maybe 3 times, maybe a little more. If a patient is montored in the hospital and they start throwing an increasing amount of multifocal PVC's then we check lytes and can usually detect a low Mg+ before it leads to this. never saw it in a pre hospital arrest.