Whats going on here?

[skivail]

I don't have a clue with what is going on in these rhythms. At first glance it looked like a pace maker had gone haywire. The problem, the Pt does not have a pace maker. The "pacer spikes" were intermittent and observed on scene, during transport, at the ER and were confirmed with the ERs ECG.

Anyone have any ideas? Everyone I have asked so far has said it is interference. I would be willing to accept that if it had only been seen in one location or just on our LP15. Seeing it in several different locations and on separate machines makes me think otherwise.

92 Y/O F
Vomiting and diarrhea X2 days
Very limited fluid and food intake for 2 days

Afebrile
Slightly hypertensive

Hx of dementia, NIDDM, depression
No cardiac history

Do not have meds available.

 

[usalsfyre]

My gut feeling is interference as well, as there's no relationship between the "pacer spikes" and the QRS, or for that matter the spikes themselves.

Don't always be sure there's no pacer. Many are implanted in the abdomen, and you would be shocked how many people don't consider them to be part of pertinent hx because the pacer "cured them".

 

[skivail]

What could cause interference on two different machines and in several different locations? The hospital 12 lead should have been clean. The pt and the family both denied any pacemaker, nurse looked for scars, bumps etc and couldn't find any evidence of one.

 

[usalsfyre]

Any tremors (no matter how small)
observed?

 

[skivail]

Nope

 

[usalsfyre]

Hmmm. Honestly don't know. The fact that a good portion of the rhythm strip is clear makes me doubt it even more, plus I haven't seen spikes like that on any pacer placed in the past 10 years.

Maybe TomB will chime in here.

 

[skivail]

I have other stips which show a much more prolonged run of the spikes. Just chose that one because it shows the underlying rhtythm as well.

 

[MSDeltaFlt]

Since that happened on multiple machines showing multiple leads tells me that the problem is not the machine nor the technician, but the pt. More accurately the pt's skin where those leads were placed. It's still artifact and completely benign. Don't sweat it.

 

[rhan101277]

I too think it is artifact or interference of something. All pacemaker's I have ever seen strips of have wide QRS and this does not.

That is why it is always taught to treat the patient, no the monitor. Many a times I will check a pulse, even if I think it is artifact just to make sure.

 

[Medic2409]

Gonna throw in with the same as the two above. I've had similar situations where those extra little spikes just show up. As long as the pt. is perfusing, BP, HR, RR, etc. etc. WNL, then they're nothing to worry about.

 

[Hockey]

Totally odd question and I am being 100% serious, was he ever abducted by aliens or had any strange encounter?

 

[HotelCo]

Totally odd question and I am being 100% serious, was he ever abducted by aliens or had any strange encounter?

 

[firetender]

There ARE Aliens Amongst us!

As long as the pt. is perfusing, BP, HR, RR, etc. etc. WNL, then they're nothing to worry about.

As a rule, it appears all of us are in Standard-Issue Earth Suits With just some minor modifications in appearance so you can tell one of us from the other.

The truth is, some of us get by with non-Standard Issue Wiring. See, the Great Whatever made us tends to do experiments and doesn't let the rest of the Diagnosticians know about it. Some stuff works and nobody knows the difference. A few generations later, it becomes part of the newest model!

In this case, the OP "caught" one of these anomalies when the Great Whatever wasn't looking. And then again, the anomaly could have easily been from something on or in the patient explaining why the rhythms matched on different machines.

Regardless, you are responding to and treating the condition of the patient to the extent that it is or will be endangering him/her. If what you see tells you there is stability enough, then minor glitches in what your machines tell you are to be noted but not fixated on.

...and then again, you may have identified a completely new rhythm dyscrasia. Let's call it the "Skivail Anomaly"!