This was an interesting run.

[buckeyedoc]

We get called to transport this lady to a heart center because she wasn't doing all that well. It was the coolest thing. She could feel the ventricular stand still coming on. The trip took us 40 minutes and this is what we saw the entire trip.

[web:e921a61d98]http://putfile.com/pic.php?pic=6/16722323584.gif&s=f5[/web:e921a61d98]

[AZCEP]

I guess lucky for her, she still was able to resume normal cardiac activity following the standstill, eh?

I don't think I'd like to watch that for very long.

[Scaramedic]

Now your dead! Now your Not!

You have about four seconds of standstill there, what was her mentation during that?

Peace,

Marty

:joker:

[buckeyedoc]

Now your dead! Now your Not!

You have about four seconds of standstill there, what was her mentation during that?

Peace,

Marty

:joker:

Right before the stand-still, she would say, "Uh, oh." She would get quiet and would nod her head when I asked her questions, but she wouldn't talk. As we were pulling into the ER, she said, "I wish they would just fix this." Sweet little old lady.

[kevkei]

That would suck.

No TCP?

[brock8024]

I will have to disagree I do not think that is standstill. The only reason I say that is there is no P waves or it does not look to have p waves during the pauses. I always thought that with standstill you would have noticeable Pwave but that was it. in that pause I do not even see the P waves.

strip one - A.Fib with RVR.

strip 2- A Fib with RVR. Then it almost looks like she either vagaled down or something and had a PJC, then have a normal beat.

strip 3- It is a brady but it is hard to tell if it is a wondering atrial pacemaker or a combo of atrial beats with junctional beat .

strip 4- It looks like strip three but then she goes back into A Fib with RVR.

Now please note that I am in my EKG interp class this summer and will be going into my cardio stuff this fall in class. So I am not a paramedic just in school for it. If someone has some stuff to teach on this please do so I love learning this stuff. thanks

Brock

[Ridryder 911]

I think one should be pacing by now.... actually those appear to escape fusion beats trying to increase the heart rate. I disagree with AVR, too slow and there the R-R is regular as well as some discernible P" waves... Great strip...

R/r 911

[RaceMedic]

Yea i agree overdrive pacing would have been good but this doesnt seem to be new to her as she knows what to expect. Secondly RVR? i am going to ASSume that you mean regular ventricular rhythm ? If that is the case i disagree if it is indeed a ventricular paced rhythm then it is an accelerated ventricular rhythm. but i doubt that as well all you are showing us is a single lead strip. ther other leads could be showing more of whats going on.. Is this off a life pack 10 ? just curious. my .02 cents anyway

Be Safe

Race

[AZCEP]

Race,

It is off of an LP12 using the 50 mm paper. The monitor ID is on the bottom of the strip at the far right.

I have a hard time thinking that this is AF. The rhythm is regular, and the "P-wave" that comes before each complex looks pretty similar. Even considering that it is only lead II that we are looking at.

Looks to me like the pause is triggered by a blocked PAC. The downslope of the preceding T-wave looks a bit funky. Besides, the most common cause of an unexpected pause is a blocked PAC, to quote a local cardiology guru. The pause in strip #2 is ungodly long, but it is still being caused by a premature complex.

I guess the adage holds, show 4 people one strip and you will come away with 4 different interpretations.

[ERDoc]

Sinus node dysfunction/sick sinus syndrome. Check out below:

http://www.emedicine.com/med/topic2132.htm