danielir

Thank You...Although there IS a RBBB, if you take a look at the 'regular 12 lead' that fiznat posted. The rhythm is clearly ventricular in origin. The complex is in fact quite wide, and the initial rhythm of trigeminy shows that there was already an irritable focus somewhere high in the ventricle, which accounts for the axis and the 'normal' R-wave progression in the precordial leads.

The initial rhythm is ventricular trigeminy. As far as the other one, I agree that the ectopic focus must be high up in the ventricles, but its definitely VT. The ectopic origin, being high in the ventricle, as well as this patients lack of medical hx may account for his ability to compensate so well, hence his maintaining BP and mental status. Those 80 beats that are perfusing may be enough to maintain homeostasis....for now. Nevertheless, this patient did have a syncopal episode, for one reason or another, and I prefer to aggressively treat VT w/ pulses. Hi-con O2, IV, and a dose of your favorite antidysrhythmic. (In NYC amidarone is now in protocol) I would definitely monitor him closely and if he became hypotensive, AMS, or otherwise unstable I would cardiovert. I would initially avoid a fluid bolus unless you could tell me that the patient has no other complaints and clear L/S. I'm sure the experts will correct me if I'm wrong, but the initial trigeminy and syncope may be a signs of impending failure, plus with his stable pressure he doesn't really need it.

chuck norris can slam a revolving door

601, respond to 123 lane for the 5 month old male with atrial...uh....atrial somethin or other.... Turned out to be a 4 month old in svt, rate was above 300 at a couple of points, pretty cool...

NYC protocols: SL nitro q5 max 3 doses(no nitrates if sbp<100 unless you have a line) 1-1.5 inches of nitropaste 20-80 of lasix CPAP if your agency has it (most dont) You can call the Doc for morphine (which can work pretty well) By the way, I have seen many tubes avoided with the use of the CPAP. It really does wonders with the bad APE's. If your agency is considering it, support it, unless of course you wanna practice your RSI.

there is NO contraindication to hi-con o2 in the field. That being said, i think it is safe to say that CP gets 4lpm via NC. If they are SOB, have ANY s/s of shock, or are otherwise unstable for any other reason ie: ams, adventitious l/s, etc, slap on a nrb. Dont be offended when the medic walks in the room and takes off the mask, replacing it with a NC, sometimes its just unnecessary.

for an adult in stat-ep in nyc, on standing orders, we can give up to 4 of Ativan -OR- 10 of Valium -OR- 10 of Versed. The protocols state, that after contacting OLMC, you can repeat the 10 of versed, for a total of 20, but thats not to say you can't get a discretionary order for whatever the doc feels like giving you. The highest dose I have ever heard of was 25. As far as dosages of benzos given in the er, im no md, but im pretty sure they can give whatever the hell they want, as long as they can justify due regard for the patient. That medical license gives them the power to prescribe, where as we have more rigid protocols telling us what we can and cant do.