spenac Posted March 8, 2009 Share Posted March 8, 2009 No pulse but an orginized rhythm on the monitor. You got two IVs Go to PEA protocol. CPR. Start your drugs. Get him intubated. Work him there as current guidelines say no rolling codes. Link to comment Share on other sites More sharing options...
Jeepluv77 Posted March 9, 2009 Share Posted March 9, 2009 When was the last time he took his meds and is there any chance he took too much of any of them? Link to comment Share on other sites More sharing options...
Kiwiology Posted March 9, 2009 Author Share Posted March 9, 2009 Go to PEA protocol. CPR. Start your drugs. Get him intubated. Work him there as current guidelines say no rolling codes. You are correct - it's PEA. Want to guess at what caused it? Link to comment Share on other sites More sharing options...
Katiebug Posted March 9, 2009 Share Posted March 9, 2009 You are correct - it's PEA. Want to guess at what caused it? Got to be the beta blocker. Link to comment Share on other sites More sharing options...
Kiwiology Posted March 9, 2009 Author Share Posted March 9, 2009 Got to be the beta blocker. Nope -- look at the ECG again Link to comment Share on other sites More sharing options...
Richard B the EMT Posted March 9, 2009 Share Posted March 9, 2009 No pulse but an organized rhythm on the monitor. "Treat the patient, not the machinery" is a mantra I learned when NY State, and the NYC Health and Hospitals Corporation EMS, first went with the EMT-Defibrillation program. A good thing for all levels of responders to go by. Link to comment Share on other sites More sharing options...
Kiwiology Posted March 10, 2009 Author Share Posted March 10, 2009 Agreed. Looks like a third degree AV block to me. Could try dopamine and epi, but I'd prolly pace em. It's not 3rd degree block because of the absence of any P waves. 3rd degree block will still produce P waves but they will be disassociated. Here is another strip (tip: look in the chest leads, note how the QRS complex goes in different directions in the same lead) "Treat the patient, not the machinery" is a mantra I learned when NY State, and the NYC Health and Hospitals Corporation EMS, first went with the EMT-Defibrillation program. A good thing for all levels of responders to go by. Thats very true. Link to comment Share on other sites More sharing options...
itxtme Posted March 10, 2009 Share Posted March 10, 2009 It's not 3rd degree block because of the absence of any P waves. 3rd degree block will still produce P waves but they will be disassociated. I dont see how you are saying there are no P waves.. I have circled some (not all) of the P waves, or what I consider to be P waves. I would call this rhythm (the top one) First Degree AVB based on the prolonged PRI, however in the two complexes I compare there is no lengthining or any dropped P waves. Maybe I am misinterpreting?? Given the patients history it would appear he is failing (CHF), the presentation to me (the first ecg) would make me query right sided MI given the bradycardia now exposed (in the ecg). MI protocol while treating the failure also.. Link to comment Share on other sites More sharing options...
p3medic Posted March 10, 2009 Share Posted March 10, 2009 Are both strips from the same patient? Link to comment Share on other sites More sharing options...
Kiwiology Posted March 10, 2009 Author Share Posted March 10, 2009 Are both strips from the same patient? Yup Link to comment Share on other sites More sharing options...
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