mikel Posted January 25, 2012 Share Posted January 25, 2012 So Im in the second and final part of my paramedic program and I got some questions about: So is there a difference on the ecg between an SA or AV block? do they look the same because I have seen in different textbooks where the heart blocks are reffered to as both nodial regions. also how can one tell between a 2nd degree heart block mobitz 1 and a sinoatrial pause? And how do you differentiate between a High grade AV block and a 3rd degree complete? does the treatment differ or is this just splitting hairs? Link to comment Share on other sites More sharing options...
island emt Posted January 25, 2012 Share Posted January 25, 2012 Sounds like you have a homework assignment to do! 1 Link to comment Share on other sites More sharing options...
paramedicmike Posted January 25, 2012 Share Posted January 25, 2012 I was thinking the same thing. Mike, why don't you tell us what you think the answer are. We can then help confirm your thoughts or point you in the right direction. Link to comment Share on other sites More sharing options...
craig Posted January 25, 2012 Share Posted January 25, 2012 research is a good thing mikel................ we have all had to do it.. best of luck, let us know what you think after your reseach and formulation of your decisions Link to comment Share on other sites More sharing options...
mikel Posted January 25, 2012 Author Share Posted January 25, 2012 hahaha...nice. thanks..I have googled the heck out of it and also read a couple of books trying to look.. i wouldnt be on here asking you peoples if I havent already googled fu'd it lol....guess I should try asking the Cardiologist on my next round of clinicals research is a good thing mikel................ we have all had to do it.. best of luck, let us know what you think after your reseach and formulation of your decisions "HAD" wow... i hope your still doing your research....JK... I understand what you meant. 1 Link to comment Share on other sites More sharing options...
DwayneEMTP Posted January 25, 2012 Share Posted January 25, 2012 +1 for attitude Mike, -1 for presentation. On this forum even isn't bad, but you can do much better....Hell, DFIB has a ton of positive points and he's like, 90, and has to have his one armed Mexican nurse type for him... I know it sounds as if eveyone is just busting your balls, and they are a bit...good on you for being able to take it. But also, to answer the questions asked any one here would have to give you an almost complete cardiology class. And that's asking to much. Doesn't your school teach cardiology as part of their criculum? If not, that sucks, but it's still your class and you're trying to repair that deficit on your own, so, good on you... I have a suggestion, though I have no idea if it's a good one... Step back from the multiple, complex questions, and just jump off of the deep end of what you feel that you know pretty well, and explain a bit of that, and then ask questions at the point where things get murky. Do you feel that you have a decent understanding of the muscular anatomy of the heart? Awesome, how about the electrical condiction system? Exactly how it works, and where, and why, to the cellular level? No? Awesome again....what do you understand? Explain that, let folks adjust it for you, and then walk on from there. See? Shouldn't take more than, like, 12 years to get the answers that you're looking for... :-) Kidding. Commit yourself to this thread for the next three or four days and you'll know more about cardiology than most of the medics that you're ever going to run across, and likely more than your teacher....Honest injun.... I'll get you started, how many types of tissues are there in the heart? What are they called? Where are they found? Dwayne Link to comment Share on other sites More sharing options...
systemet Posted January 25, 2012 Share Posted January 25, 2012 (edited) So is there a difference on the ecg between an SA or AV block? Question 1: Can we observe SA activity on a standard surface ECG? Question 2: What happens to a the P wave in an SA exit block? Queston 3: Is the P wave altered in AV block? do they look the same Given the above, what do you reckon? (Not trying to be difficult, I mean this in a friendly way). because I have seen in different textbooks where the heart blocks are reffered to as both nodial regions. Question 4: What does nodal and infranodal AV block mean? Does either of these have anything to do with SA node function? also how can one tell between a 2nd degree heart block mobitz 1 and a sinoatrial pause? Question 5: What is an SA pause? http://drsvenkatesan...is-sinus-pause/ And how do you differentiate between a High grade AV block and a 3rd degree complete? Question 6: What is a high grade AV block? Is it possible for something to be a high grade AV block, but not a 3rd degree? does the treatment differ or is this just splitting hairs? Question 7: What is an escape pacemaker? Question 8: What regions of the heart are more likely to be atropine-responsive, i.e. have more vagal innervation? Question 9: Is it possible for an escape pacemaker to be atropine-responsive in a 3rd degree AV block? Question 10: What are the 2011 ECC (ACLS) guidelines for bradycardia? What are the primary factors determining treatment? Hey, it's great that you're interested in this. Keep posting. Edited January 25, 2012 by systemet Link to comment Share on other sites More sharing options...
mikel Posted January 25, 2012 Author Share Posted January 25, 2012 My program does have a very in depth cardiac section... Actually the majority of my class work leads me to most of my research way farther in depth than the nremt level, which isn't saying much but sometimes I'm not sure where to draw the line between what I need to learn to pass and what is frivolous reading at the present time. I do thank you guys for your insight and direction.. I will keep on reading..besides it'll help me in my PA school in the fall:) Link to comment Share on other sites More sharing options...
LegendaryPunk Posted January 30, 2012 Share Posted January 30, 2012 Since it’s been a few days since mikel’s last post, I’d like to take a stab at actually answering some of the questions he posted. I JUST completed my written and practical exams (as in <1 week ago!), which has made me feel more strongly than ever before that I should be spending time in the Students sub-forum. So please, feel free to rip my response to shreds if it will help me identify what I don’t know. First I’d like to make sure I have my terminology straight… - SA block: impulse in generated in the SA node, but doesn’t get any farther than the initial depolarizing cell – issue of conductivity - SA pause (or arrest): SA node fails to generate an impulse – issue of automaticity - AV block: impulse is generated in the SA node, depolarizes the atria, but has difficulty reaching the ventricles, if it makes it through at all - issue of conductivity - High grade AV block: different terminology for complete (3rd degree) AV block? SA block would be difficult to identify, as the ECG only allows us to see atrial depolarization (P wave). So, we see what happens AFTER the SA node fires and the appropriate cells respond, but we cannot detect the pacemaker cell itself firing. On the ECG, SA block could appear as a complete dropped beat, or as an escape beat. I seem to remember learning something about the timing of the P-P intervals being a clue as to the difference between SA block and SA arrest, but I don’t remember that off-hand, and I’m trying to not cheat and look anything up AV block would present with a normal P wave, followed by tracings indicative of whatever degree AV block is present (delayed, going going gone, sudden QRS drop, or complete dissociation). Treatment would be based both on how the patient presents, as well as the type of block encountered. - SA block / arrest followed by an atrial or junctional escape, with the patient sitting, smiling and going on about his grandkids? Let him be. - 2nd degree type II, 3rd degree or your patient appearing diaphoretic, pale and confused? Get ready to provide some Edison medicine because these blocks have a high chance of continuing to degrade, or your patient has already started decompensating. Bradycardia should also be treated w/ 0.5mg Atropine, unless you have 2nd or 3rd degree, in which case the drug will have no effect. 2 Link to comment Share on other sites More sharing options...
mobey Posted January 30, 2012 Share Posted January 30, 2012 First off: Very nice post. Spelling & format is very professional, nice to see from a forum noOb! Now to the meat: - SA block: impulse in generated in the SA node, but doesn’t get any farther than the initial depolarizing cell – issue of conductivity Correct, this will manifest itself in dropped beats. Dissect the term Sino-Atrial block. That is a pathway.... not a node! The node is a Sinus node. http://www.merckmanuals.com/professional/cardiovascular_disorders/arrhythmias_and_conduction_disorders/sinus_node_dysfunction.html SA pause (or arrest): SA node fails to generate an impulse – issue of automaticity Right, a pause in the pathway between the P-cells of the Sinus node, and the T-cells or the "highway" to the atria. http://www.uptodate.com/contents/anatomy-and-electrophysiology-of-the-sinoatrial-node AV block: impulse is generated in the SA node, depolarizes the atria, but has difficulty reaching the ventricles, if it makes it through at all - issue of conductivity This is a block within the AV-Node. On the ECG, the block is seen between the P-wave and QRS. Therefore the QRS (if present) is not initiated from the AV-node. This is 3rd degree "complete" heart block. Partial or 2nd degree Type 1 are partial blocks, where the AV node fails to conduct to the bundle branches periodically, can be 1:1, 2:1, 3:1 etc. 2 Link to comment Share on other sites More sharing options...
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