scott33

Because the puzzle was solved by the second post.

Look again at the PRI and shape of the p-waves, particularly on lead II and III on the 12-lead trace. Nothing is the same - variable PRI, notched P-waves, pointed P-waves, biphasic P-waves, retrograde P-waves etc. Perhaps the OP can scan it a little larger for those in doubt.

The rate. MAT = >100, WAP = <100

An irregular rhythm >100 with some noticable p-waves and other morphologies that resemble p-waves. Narrow QRS, and a p-wave, or p-wave type shape before every QRS. Using the above we can rule out all ventricular, rhythms and afib. Could it be a sinus arrythmia with PJCs or PAC's? perhaps, but the fact that you can clearly see variable different forms of p-waves and the associated irregularity of the rhythm as a whole, would lead me to think MAT before any other rhythm. The origin of impulse is in and around the sinus node, with some foci being nearer the AV junction (shorter PRI) and some being further away (longer PRI and those noticable retrograde-antegrade P-waves). Here is another confirmed one for comparison http://www.emedu.org/ecg/images/ans/2mat_1.jpg Sticking with my first choice

Do you not have a rotation in a phlebotomy lab first?

Looks like MAT

This fat pig should have lost his license at the very least, not just have been suspended. More here, as well as his Fitness to Practice hearing from his governing body.

http://www.nct.org.uk/info-centre/publications/view/35

When are they going to learn? Never use anything you can lose up there, and FFS not glass! So he was torn a new arse hole...twice.

More importantly though, be careful with those nitrates.

I was always led to believe that Cocaine use was one of the causes of Prinzmetal's Angina. http://en.wikipedia.org/wiki/Prinzmetal's_angina Still right to treat as MI Edit: More here... http://content.nejm.org/cgi/content/full/349/1/e1

1. Do you routinely determine the mean QRS Axis and can you apply that information practically? Yes, I usually determine it, as I use the easy-peasy Bob Page way, but don't always document the info it as it can mean many different things, including nothing at all. 2. Are you aware of the Sgarbossa Criteria and have you used it before? I know what it is, but haven't learned how to apply it from memory. LBBBs will still get fast tracked to STEMI centers as a R/O MI in many places 3. Do you routinely check for Cor (or P) Pulmonale? Yes, I find the right side of the heart far more interesting 4. Do you look for LVH, BER, and BBB on every STEMI? No 5. Do you systematically interpret every 12 lead you read in the same order every time? No, poor practice on my part. 6. How familiar are you with syndromes like Brugada, Pericarditis, Wellen's, WPW, hyper/hypo K, and long QT? Familiar enough to spot it on a good 12-lead trace as they have pretty unique morphologies. That is, with the exception of Wellens. Never heard of it. Others....? I always look at right side with inferior wall involvement by moving V4 to V4R. Usually like to see what part of heart was affected, with those who state they have had an MI in the past. Just for the hell of it. Always tell myself to look out for S1, Q3, T3 with any sudden onset of SOB... and always forget. Have been guilty of looking at the cool stuff before the underlying rhythm

http://www.informedguides.com/index.cfm?ev...=viewAllDigital http://www.informedguides.com/index.cfm?ev...+Medical+Guides

The UK has always had the issue of the working class subsidising those above (HRH and her buddies) and those below (the dole merchants). I am guilty as charged of chosing unemployment over dead-end job in my teens, as it was very accessable when I was in my youth. Free money! These days, there are limits and conditions, and one has to be actively looking for work to claim unemployment benefit, but it is not impossible to live your entire life, never having either worked, or broken the law. The problem is with those who abuse the system. More recently, some of the more heated issues are more related to the freedom to live anywhere in the United States of Europe, and the British invasion of non-English speaking, non-skilled aliens who (and I will put this in quotes) "are given free houses, free food, and our jobs" is causing malcontent similar to that in the US. Those less wealthy and more recent countries to join the EU (Bulgaria, Romania, Estonia...) have the same rights of passage in any European Union country, as someone in Nebraska would have, if they wished to move to Maine. It's just a case of packing up and moving. From the UK perspective, I can see the argument, but I have noticed the loudest voices occasionally come from those who have been milking the system for years.

Yeah, I know what happens, I heave heard it discussed at work, and there are many "reaction" videos on YT. Just can't watch it. Didn't think it was that video you were referring to. I see these poor souls present to the ED a few times, but usually their "weapon of choice", is still intact. Usually the middle-aged professional males with a wife and kids. Some people need a new hobby. Wonder if he died.

No no no no!!!!! 3 seconds. That's all folks

You know, I really can't argue that point. I have a friend in the UK who took serverance pay from his old job (in fact we both took it at the same time about 10 years ago). Difference being, he has opted out of the whole "working" thing, and he pretty much gets by on government benefits. That's not working smart either, that's just bloody lazyness.

Edited: off topic

Let's see – route of choice for administration of life-saving ACLS meds, route of choice for administration of blood and blood products, route for of choice for induction of pre-surgical anesthesia for life-threatening conditions, route of choice for administration of fluids / pressors to sustain viable MAP, route of choice for administration of certain antitoxic agents, route of choice for administration of antibiotics for meningococcal septicemia, or bacterial PNA / sepsis, route of choice for the timely adminstration of thrombolytic agents for CVA / MI, etc, etc. You could use your argument for any other single intervention out there, including O2 administration. Point being, IVs are used in conjunction with continued care, and have been integral in saving many lives. Lives which may have been lost if access was unobtainable or delayed.

progressive thinking Admin, can we have a weekly "silliest thing stated on an internet forum" section please?

I think you will find it was intentionally evenly balanced, or at least the best I could do without bending the truth. The term is subjective, and in reference to the general work "ethic". As I said, I was speaking from personal experience of working and living in both countries for many years, and under many different employers. I wonder if anyone else can share the same experience, or if they are merely chipping in conjecture, based on not knowing what they don’t know. For the growing Army of doubting Thomas’s, you may want to look (closely) into the fundamental differences in healthcare manual handling regulations between both countries. Then you may see where I am coming from. Ambulance hydraulic ramps and stretchers, a much greater emphasis on encouraging the patient to ambulate if no contras (apparently some places in the US will "carry" the patient to the ambulance for a cut finger - as recently revealed in a thread on EMT life), not to mention the "no lift policy" in effect for UK healthcare workers. The use of slide sheets, inflatable lateral assist devices, and hoists are the norm, not the exception. I would be lying if I said it had eradicated stress injuries though, and I know machinery can break, but a step in the right direction. Working smarter, not harder.

care to explain

The work ethic is one of the biggest differences between cultures I have seen. You are not going to get someone in the UK bragging about having 3 jobs, when they can easily get by with one. As a generalization, just with what I have experienced working in both countries, and by no means typical of every job or profession... US - spend less time off sick UK - spend more time on vacation US - has more jobs UK - has more job benefits US - has higher wages for the same job, even factoring in the exchange rate (paramedic pay is less though) UK - pay more tax US - need to consider healthcare insurance UK - has more people to fight your corner if you lose your job US - everyone is expendable and replaceable UK - doesn't nurture, subsidize, and encourage professional development US - does UK - meal breaks are a right US - meal breaks are a privilege US - the constant fear of litigation drives working practice UK - not nearly to the same degree ergo... US - work harder UK - work smarter Both places have their good points and bad points as far as employment goes.

Look at the link. The reference was to the UK and fox hunting. Foxes are pests, no doubt, but rabies are pretty much non-existent in the UK. Maybe it's all the rain.

Hardly... http://www.hpa.org.uk/webw/HPAweb&Page...e/1191942176094