FireMedic65 Posted April 18, 2009 Share Posted April 18, 2009 Thank you all so much for this info. I can't wait to get those books, akzroeze. Thank goodness I have a birthday coming up because they are not cheap! And, like Aaron said, thank you chbare for taking the time to explain it. I might be stopping at emt-i for awhile(still not sure) but I don't think that should mean my learning stops in August when I test out. Even though I won't "officially" be able to read 12-lead on rescue, I will be able to as an in-hospital tech. Either way, it will definitely help my patients if I have a better understanding of what's going on with them. I'm going to check on protocols to and see if I can take 12 lead early as part of my emt-i but I doubt it because I think it's out of our scope of practice. Hence the can't "officially" read it and may not be able to fully treat it, but at least I can anticipate problems and hopefully have some idea of what I'm up against during transport. anyone can a 12 lead course Link to comment Share on other sites More sharing options...
celticcare Posted April 19, 2009 Share Posted April 19, 2009 Thank you CHBare, its good to hear it in the plain and simples also, I can see it on a screen, I can understand it plainly, but you've given that extra help also. Kinda the little light clicked, so from one nurse to another, thank you. Just a question too, in patients who have undergone CABG, I know I have pathological changes that remain like ST elevation and Q waves etc, in patients with heart transplants, what sort of changes would I expect? We don't exactly get many heart transplants here and haven't care for one yet, cared for them pre transplant but never saw them again post transplantation. Many thanks again. Link to comment Share on other sites More sharing options...
chbare Posted April 19, 2009 Share Posted April 19, 2009 Thank you CHBare, its good to hear it in the plain and simples also, I can see it on a screen, I can understand it plainly, but you've given that extra help also. Kinda the little light clicked, so from one nurse to another, thank you. Just a question too, in patients who have undergone CABG, I know I have pathological changes that remain like ST elevation and Q waves etc, in patients with heart transplants, what sort of changes would I expect? We don't exactly get many heart transplants here and haven't care for one yet, cared for them pre transplant but never saw them again post transplantation. Many thanks again. No worries, cheers mate. ECG changes status post transplant can vary from AV blocks to ventricular conduction problems. Obviously, complications such as pericarditis can also cause changes. Some of the more interesting changes include two P waves and two different QRS complex morphologies. This is especially common in "piggyback" transplants. Take care, chbare. Link to comment Share on other sites More sharing options...
FL_Medic Posted April 19, 2009 Author Share Posted April 19, 2009 Back to the rhythm in question. So we are stating that this is surely a bundle branch block? What about the poster that mention paced morphology? Link to comment Share on other sites More sharing options...
chbare Posted April 19, 2009 Share Posted April 19, 2009 You are looking at V4 & V5? Take care, chbare. Link to comment Share on other sites More sharing options...
FireMedic65 Posted April 19, 2009 Share Posted April 19, 2009 well, I don't want to cheat or anything, but when you enlarge the picture, it's labeled pacer-1.jpg Link to comment Share on other sites More sharing options...
chbare Posted April 19, 2009 Share Posted April 19, 2009 True, however, do we actually have a paced patient? Cannot definitively ID this with the strip available. As stated, a paced patient with capture is in no mans land regarding XII lead findings. With the exception of pacemaker related concepts. (sensing, capture, and such) Take care, chbare. Link to comment Share on other sites More sharing options...
FireMedic65 Posted April 19, 2009 Share Posted April 19, 2009 True, however, do we actually have a paced patient? Cannot definitively ID this with the strip available. As stated, a paced patient with capture is in no mans land regarding XII lead findings. With the exception of pacemaker related concepts. (sensing, capture, and such) Take care, chbare. I was just being a smartass I am sticking with it being a bundle branch. btw, those using firefox.. if you press the ctrl and + it "zooms" in. you can get a nicer view of the strip using it. (ctrl and - will zoom you back out) Link to comment Share on other sites More sharing options...
fiznat Posted April 19, 2009 Share Posted April 19, 2009 (re-quoted the strip so we don't have to keep going back to the 1st page) I'm really not sure what this is. Looks like we have a regular, borderline wide-complex rhythm at about 100 bpm. I see P waves that correspond to the QRS in regular fashion and are of regular, consistent morphology. The P-R interval may be a little bit long, but it is difficult to tell on the small tracing. There appears to be a right bundle branch block as well. Based on the above information I would consider calling this a sinus rhythm with RBBB, possibly a 1st degree AVB. However, there is left axis deviation and the R-wave progression through the chest leads is really funky. These changes could be due to the abbarancy in conduction through the ventricles, or it could be a hint about an alternate origin of the rhythm. With everything else, though, I think I would still call this sinus with RBBB. I'm not seeing any evidence of a pacemaker here, though I could be wrong. Good strip! Link to comment Share on other sites More sharing options...
FL_Medic Posted April 19, 2009 Author Share Posted April 19, 2009 You are looking at V4 & V5? Take care, chbare. Yes I was. Also, I realized that I tagged this as Pacer-1, but I still don't have the rhythm analysis from whom I receive these anyhow. I am assuming that this is a ventricular pacemaker, but that is not definitive. I noted the bifasicular block, and deviation. This made me question what might cause this pattern, and a paced rhythm could cause this, along with ST-elevation. I'd say, a pretty low voltage implanted ventricular pacer. Link to comment Share on other sites More sharing options...
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