FL_Medic Posted May 11, 2009 Share Posted May 11, 2009 No problem. I don't mean to be critical, I just saw a moment to teach. Check out my blog sometime, and for some good EKG stuff.... ems12lead.blogspot.com. Link to comment Share on other sites More sharing options...
celticcare Posted May 11, 2009 Share Posted May 11, 2009 I'm actually going to be pleased to take a break from ecgs for a while with finishing my current job..... though would be nice for a hardcore resistant VF arrest either tomorrow night or on mylast night that will be awesome especially as the patient will come back after my 5th shock muwahahahahahaha Link to comment Share on other sites More sharing options...
Diazepam618 Posted May 11, 2009 Share Posted May 11, 2009 To the op, you said sync cardio, I would totally agree with given the example of distress in your fire couple of senteces. Link to comment Share on other sites More sharing options...
celticcare Posted May 12, 2009 Share Posted May 12, 2009 To the op, you said sync cardio, I would totally agree with given the example of distress in your fire couple of senteces. But it is not fast AF, his bp is still holding, a fuild challenge calmed him down, it would be more fear of Oh my god is this another heart attack? You seriously want to knock this guy out, bring the black shiny paddles in front of him first though, and then zap him when he doesnt need it???? Maybe perhaps it is in your protocols to which then I will accept it, but the general idea would be chemical before electrical. Electrical only if heamodynamically unstable. Link to comment Share on other sites More sharing options...
jwraider Posted June 6, 2009 Share Posted June 6, 2009 (edited) Thanks for this I got to review a rarely used protocol we have. For symptomatic uncontrolled afib we can give a bolus of NS and then move to cardioversion if the PT has a BP under 80 and other severe symptoms (CP, ALOC). I think when deciding on how to treat this guy the NS is a no brainer (nitro dropped his pressure and preload afib did the rest) but cardioversion is a tougher choice. For me it depends on how this guy will end up presenting at the hospital and what they will do. I highly doubt they'll jump to amiodarone they would go with a CCB most likely or cardio version. (For me Amiodarone has some scary side effects and shouldn't be tossed around outside of an arrest or VT with a pulse). So if his BP continued to fall and or he developed ALOC I think I would cardiovert. Thanks again. Edited June 6, 2009 by jwraider Link to comment Share on other sites More sharing options...
Coyote Medic Posted July 22, 2009 Share Posted July 22, 2009 I hope someone is still reading this post. I have a few questions. 1. celticare-How did you decide on a LBBB from what was shown? 2. Mobey-I was wondering why you thought about amioderone and was also wondering if they let basics do 12 leads in your area. I am not questioning to be a dick. I am making sure there is not something I should be studying a little more. I am taking the NC state paramedic exam this Friday. This is all for the learning aspect. Link to comment Share on other sites More sharing options...
Mateo_1387 Posted July 22, 2009 Share Posted July 22, 2009 I hope someone is still reading this post. I have a few questions. 1. celticare-How did you decide on a LBBB from what was shown? 2. Mobey-I was wondering why you thought about amioderone and was also wondering if they let basics do 12 leads in your area. I am not questioning to be a dick. I am making sure there is not something I should be studying a little more. I am taking the NC state paramedic exam this Friday. This is all for the learning aspect. Mobey, hope you do not mind me jumping in. Correct anything I have to say. To Coyote, FL Medic wrote a post on this thread about complete and incomplete left bundle branch blocks. He made a good post. It is worth the read. As for using Amiodarone, I believe Mobey though about using amiodarone to control the heart rate. I could tell you about Amiodarone, but reading and learning on your own may be better. Go to the link below, and go to page 6 to read about the mechanism of action of Amiodarone. http://www.rxlist.com/amiodarone-hcl-injection-drug.htm Enjoy ! Also, good luck on the exam ! Mateo Link to comment Share on other sites More sharing options...
chbare Posted July 22, 2009 Share Posted July 22, 2009 I am not a huge fan of A-Fib rate control or conversion in the field if it can be avoided. With this guy's history, it is difficult to know exactly when the A-Fib started. Has he been in A-Fib for a while and suddenly threw a small PE, or is this a true new onset A-Fib? If possible, I would rather have somebody above my pay grade make that determination. With the exception of the tachypnea, this patient is not in extreme distress. Therefore, I would not go with an aggressive treatment plan for a 20 minute trip to the hospital. Pain control and judicious fluid therapy sounds like a good option. We can monitor vital signs and obtain a blood glucose along with serial XII leads. As far as giving amiodarone to this guy: Amiodarone is well known to have significant pro-arrhythmic effects and has multiple medication interactions along with complex actions and pharmacokinetics. Therefore, the risks must be weighed against the benefits. In this case, I would not go down this path with the current information available. Again, I will defer the decision to administer this agent to somebody above my pay grade. Take care, chbare. Link to comment Share on other sites More sharing options...
speedygodzilla Posted July 22, 2009 Share Posted July 22, 2009 Paton me as I am still learning, but the 2nd ECG of just lead 1 or 2 doesn't look like A-Fib as it is not irregular-irregular? It has about 9 squares between the peek of the QRS in each complex until it changes over to about 11 squares. What am I missing? Thanks Nate EMT-B EMT-P Student Link to comment Share on other sites More sharing options...
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