I would like your opinion about a funky EKG

[boneknuckleskin]

I could, but obviously you do not understand cardiology well enough to understand the answer so I won't waste my time. I'll just leave you with one word to ponder: multifocal.

Go spend a week with the Dubin book, then a few months in a hospital reading 12 lead EKGs (not staring at a monitor), then get back to us if you still have any questions. If you have never seen A-fib present semi-regular, you obviously weren't a monitor tech for very long. Or else you simply sucked at it. I've seen it twice this week.

And barging in here to tell everybody they are wrong when you yourself can't even tell us what is correct is just plain stupid.

Oh, and occurrence is spelled with two Rs.

Minus five for not using spell check.

Minus five for replying to a topic that has been dead for four months.

Minus ten for the most horrible first post I have ever seen made on this forum.

You're confused, by you own admission you state P-waves are visible but "don't quite" march out. Where? And please explain when isolated, discrete P-waves became identifiable at all during A-fib? Show us all.

Atrial fibrillation is a multifocal rhythm. Nothing more than a run of "irregularly irregular" multifocal PAC's. The baseline should be too fibrillatory to discern any junctional activity, and many PVC's witnessed during A-fib are often later found to be Ashman's phenomenon during an EP follow-up. This is a problem. Ashman's is an abberation that occurs when a stimulus falls in the absolute refactory period. That period is lengthened during a slower heart rate. Remember, the slower the rate, the slower the refractory period, the faster the rate, the shorter the refractory period. During A-fib, when ectopy appears following a short RR interval, preceeded by a long RR intervral, it can be assumed that the long RR sets up a slower recover period for the conduction tissue. The distal conduction tissue is not completely recovered, and when challenged by an early impulse, will result in a intermittent RBBB. Not a PVC. This is common and not exclusive to A-fib. The moral of the story? Don't treat with lidocaine. It can speed AV conduction and turn your somewhat stable A-fib patient into a code. Ask an electrophysiologist.

If your PR interval is changing and the morphology of the P-wave is as well, as in this case, you're dealing with a wandering atrial pacemaker or multifocal atrial tachycardia - depending on rate - both of which are multifocal rhythms and almost exclusive to the elderly populations. It's not uncommon for these patients to self convert between multiple arrhythmias and ectopy patterns in a short period of time. Look at the big picture. I am. And what I see is a practicing paramedic who is clearly in need of a refresher course in basic cardiac rhythm strips, as well as 12-leads. As a provider, your decisions may help steer the pre-hospital treatment of a patient and you are dangerously incomptent until you can correctly identify simple dysrhythmias, so until then, use an AED.

[Dustdevil]

As a provider, your decisions may help steer the pre-hospital treatment of a patient and you are dangerously incomptent until you can correctly identify simple dysrhythmias, so until then, use an AED.

As a provider, I treat the patient, not the monitor. That's the first thing the competent among us learned, and we practise by it. The problem here is that you haven't been treating anybody or anything. You've just spent a lot of time staring at 3 lead monitor screens and thinking you understood the squiggly lines. There is a big gap between theoretical and reality that you have yet to grasp. Back to school with you.

BTW, I notice that in your zeal to tell everybody how wrong they are, you still haven't told us what the rhythm is. Interesting.

And wtf said anything about lidocaine? :roll:

[Scaramedic]

You're all wrong. Especially you.

Can any of you highly educated EMT-paramedics explain how it would be possible for PJC's to co-exist with a underlying junctional rhythm? Or PAC's within PAT? Or PVC's during the occurence of VT? Enlighten me.

RN's are rarely the best judges of any rhythm.

And what I see is a practicing paramedic who is clearly in need of a refresher course in basic cardiac rhythm strips, as well as 12-leads. As a provider, your decisions may help steer the pre-hospital treatment of a patient and you are dangerously incomptent until you can correctly identify simple dysrhythmias, so until then, use an AED.

You've got a giant set of nuts I'll give you that. You come into this forum and your first post is to correct a group of people who probably have ten times the street credentials than you do. You seem to have issues with both Paramedics and RN's, two groups of people who have a higher education than you. Yet you seem to believe you are an expert in electrophysiology because you are a monitor tech, guess what your not.

Luckily for you I have to go, please standby for a further rant. :angry4:

Peace,

Marty

:joker:

[boneknuckleskin]

[DwayneEMTP]

boneknuckleskin,

Perhaps you are all of those things. If so why are you having such a hard time seeing that people are not going to give your opinions any weight when you don't seem to be able to give your own interpretation of the strip.

It will not longer be necessary to keep telling everyone what idiots they are once you explain the strip and show them why they are wrong.

Other than being an ass simply for the sake of making a scene, it does seem you have something to offer.

Shut em up by proving your point.

Dwayne

[chbare]

Boneknuckleskin, DwayneEMTB is correct. You are among several other people who think this strip is not A-Fib. However, they have given their interpretation and in many cases a rationale to back up their findings. In addition, they have not directly attacked another profession. As a Nurse I can say that I am not offended by the Nurse comment, however, you need to give us your rationale. You cannot just tell people they are wrong and then specifically point out somebody and tell them they are wrong without having some hard evidence to back up your position. You cannot continue to play the "highly educated mystery medical man." "It's time to poop or get off the pot."

Take care,

chbare.

[Scaramedic]

Assume nothing. I have not given you my current credentials, and I don't wear them on a shoulder badge. I'm well educated, well written, and extremely well read. I've given you my theory; now tell everyone about the A-fib, nurse Dusty!

...Rant continues.

Your arrogance is astounding. Unless you have M.D., F.A.C.C. behind your name and work at the Mayo clinic your arrogance is unfounded. To debate the rhythm presented is really futile. For starters it's only in one lead, and its not a very good tracing at that. If you believe that you can adequately interpret a rhythm in one lead you are misguided. There is a reason we have so many leads to look at the heart. We look at different leads to garner info from various aspects of the heart. What you see in one lead might steer you in the wrong direction, that is why you look for info in another lead. You have the typical monitor tech attitude, I can diagnose anything from leads I, II, and III. You say your well educated, written and read, yet you are a monitor tech. Hmmm interesting, doesn't monitor tech require like a sixteen hour basic EKG class? It seems to me that Nursing and Paramedicine have a little bit higher standards.

Also do not come into this forum looking for fights, we tire of that crap really quick. Dust has made his bones on this forum, he is respected and his views are appreciated. You on the other hand are a troll, so please find a spot under someone else's bridge to hide.

Peace,

Marty

:joker:

[redwolfef6]

Very interesting strip. (BTW sorry about chiming if this subject is already dead.)

My initial thought was A Tach converting to, possibly, a junctional rhythm. I sent a copy of the Pt hX and the link to the strip to my old paramedic instructor, he is considered an EKG guru, His thoughts were: He would like to see other leads and from what he saw thought it was a Rapid A Fib with Ashman's.

I am definitely going to do some more research on Ashman's.

Excellent strip and subsequent discussion, definitely a learning point.

[uglymedic]

Paroxysmal flickets? With FLB's?

Was the patient feeling woogity? Could be terminal.

:wav:

ug

[medic_4_life]

OK just had to an O P R ........... Old persons rhythm