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FL_Medic

Strip Tease 8

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Okay, this one isn't on my blog yet. Thought I'd get another one up quick because the last one was answered so quickly.

StripTease8.jpg

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Edited by FL_Medic

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Aw jeez ...here's what I see

- its a regularly irregular rhythm of about 50

- looks like AF

- could be a ventricular rhythm or third degree block

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To my not quite trained eyes it looks like a 2nd degree type 1. Hard to tell because it's so slow and there are only 2 p waves and 2 qrs complexes. But I did noticed the second pri was much longer than the first. However, I could see it also being a 3rd. Those that are more experienced will probably be able to tell, but this is when I'd be hitting the print button on my monitor and getting a lead II print out. As far as treatment, would you pace? I'm guessing atropine wouldn't work if it's a block. We were taught it only works for brady originating above the av node.

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Adam,

Its a complete heart block with artifact. It actually threw me off thinking it might be A-fib with the complete heart block, but if you look closely there are numerous P waves found in the pericordial leads. They don't map out, giving way to complete AV dissocation, meaning complete heart block. Atropine is not the treatment of choice here. If it's asymptomatic, you watch and monitor close. If he's symptomatic: postion of comfort, NC @ 2-4 lpm O2, IV access, have someone ready the pacer and apply it, begin pacing and start a dopamine drip 5-20 mcg/kg/min for perfusion. Repeat 12 leads while enroute with ETCO2, SPO2, BGL, and Temp monitoring.

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ST7.jpg

3rd degree(Complete) AV heart block.

Note P-P intervals stay consistent.

R-R intervals generally stay consistent with these AV blocks as well.

There is complete AV disassociation. This is why the QRS complexes widen with complete heart block.

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Third degree with BBB.

Which type of BBB and where do you see it?

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Right BBB seen in almost all leads to me

You are not getting off that easy. What do you see in all leads that says RBBB?

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It is a LBBB, as the QRS is wide (its borderline at 0.12 sec), negative in V1 and the underlying rhythm is supraventricular in origin

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