Complex cardioversion?

[AZCEP]

Ruff, Do you make it a habit giving a beta-agonist to a person with a tachy arrhythmia? Let's make a sick heart work harder, why don't we!!

Broke, YOU ALWAYS FIX DYSRHYTHMIAS BEFORE YOU DO ANYTHING ELSE!!!!! They will compensate for only so long.

I'm not going to try to answer for Ruff, since I don't know him. This heart is working as hard as it possibly can. a dose of a beta-2 agonist will not change that. If you are using something like Isuprel, you might get a bad effect, but very few carry it.

You might want to recheck your ACLS book also. If you are presented with a reversible cause, you treat it first. Fix the oxygen problem, the rate will be easier to manage.

[Just Plain Ruff]

Ok fire, in deference to you, no I do not routinely give beta agonists to patietns with sick hearts but I was simply responding to this scenario where they helped this patient.

The way I'd be managing this patient would be

1. Controlling this guys airway

2. Reversing the breathing problem with an albuterol treatment and getting my intubation supplies ready.

3. I'd be putting on the defib pad/pacer pads on this patient also.

4. I'd be on the horn with medical control getting additional orders if needed

this is one very very critical patient and I'd be correcting the deficets as they present to me, Airway first - is it open Breathing second - is he breathing or how's he breathing. Take the signs and symptoms and presentation of this scenario and you get a breathing treatment and more than likely ventillatory support.

Finally you get to circulation - once you start a treatment you wait a reasonable time for that treatment to wait.

In my opinion cardioversion could be considered but only after you begin to treat the underlying cause which is respiratory failure. It's amazing how the body can respond which is proven in the outcome of this scenario.

If I was a green medic out in the field I would have probably taken one look at the rhythm and said OMFG we gotta cardiovert this guy but after a little more field experience I would look towards underlying causes rather than going to electricity.

But then that is the way I'd treat him.

The good thing is, it sounds like this patient survived and that's what counts.

Was cardioversion wrong? who knows, we will never know if it was wrong because the medic in question in the scenario Brock reposted didn't get to cardioversion.

[Just Plain Ruff]

Ok fire, in deference to you, no I do not routinely give beta agonists to patietns with sick hearts but I was simply responding to this scenario where they helped this patient.

The way I'd be managing this patient would be

1. Controlling this guys airway

2. Reversing the breathing problem with an albuterol treatment and getting my intubation supplies ready.

3. I'd be putting on the defib pad/pacer pads on this patient also.

4. I'd be on the horn with medical control getting additional orders if needed

this is one very very critical patient and I'd be correcting the deficets as they present to me, Airway first - is it open Breathing second - is he breathing or how's he breathing. Take the signs and symptoms and presentation of this scenario and you get a breathing treatment and more than likely ventillatory support.

Finally you get to circulation - once you start a treatment you wait a reasonable time for that treatment to wait.

In my opinion cardioversion could be considered but only after you begin to treat the underlying cause which is respiratory failure. It's amazing how the body can respond which is proven in the outcome of this scenario.

If I was a green medic out in the field I would have probably taken one look at the rhythm and said OMFG we gotta cardiovert this guy but after a little more field experience I would look towards underlying causes rather than going to electricity.

But then that is the way I'd treat him.

The good thing is, it sounds like this patient survived and that's what counts.

Was cardioversion wrong? who knows, we will never know if it was wrong because the medic in question in the scenario Brock reposted didn't get to cardioversion.

[Thunderchild145]

AZCEP beat me to it, but yea that question was already covered on this thread. Catecholamines and beta agonists aren't going to speed this guy up any farther.

But honestly, why cardiovert first? If a tree falls in a forest and no one's around to hear it, does it make a noise?

Wait. Wrong mantra. If you cardiovert someone and their heart is too hypoxic to restart, is it your fault you just sent them into cardiac arrest?

Uh. Yea. It is.

[Just Plain Ruff]

Thunder, that is exactly the point we're trying to make.

[brock8024]

See it is amazing that I was flogged for the treatment that I would have done for this patient, and was told that someone hoped I was just starting out as a medic student and never to come to PA to practice. Well I am graduating soon, may to be more to the point. I will never come to Pa. is this is how people are treated.

See I was taught that is a heart is hypoxic you need to fix the hypoxemia before moving on. This is why we now do 2 mins of CPR before we defib a patient, and why we can do 2 mins of CPR after we get a pulse back to help the Hypoxemia and acidosis.

I still think that it was a respiratory problem that caused the tachycardia. I mean how many people can have SHOB for 2 DAYS and have that much edema and it be from a tachycardia? I doubt this guys heart had been going that fast both days. I am sure he got into a CHF or COPD problem did not call and though he could do ok on his own or would not let his wife call EMS. Then as time went on from his breathing difficulty, his heart speeds up to compensate for the impending respiratory arrest.

I think that if we was to caridovert first one of two things would happen

1) We would send him into cardiac arrest

2) we would convert him but he would speed right back up due to the hypoxemia

Brock

[scratrat]

Ruff, Do you make it a habit giving a beta-agonist to a person with a tachy arrhythmia? Let's make a sick heart work harder, why don't we!!

Broke, YOU ALWAYS FIX DYSRHYTHMIAS BEFORE YOU DO ANYTHING ELSE!!!!! They will compensate for only so long.

If someone is wheezing and SOB and has a HR of 150 then what? Just immediately give adenosine since it's tachycardic and nevermind the fact that he's wheezing? Cause you know, you have to treat the dysrthythmia first......

So no matter what the pt presentation is, if they have a dysrthythmia, you MUST fix that FIRST?

Answer the only posters questions.....how long have you been a medic again? Just morbid curiosity....

[Just Plain Ruff]

Well I'm done asking the questions of this so called perfect paramedic. He has never once responded to any question that I have had except to be condescending and rude.

I have also sent him two pm's which he has never replied to. Common courtesy would be to respond to questions asked. Apparantly responding to simple questions asked of him is beneath him. Or maybe he just isn't responding due to the fact that he will be shown as a newbie medic with A LOT TO LEARN both about common courtesy among other things.

so I'm done with this perfect paramedic who's you know what doesn't stink.

Bleh

[firefighter523]

Scrat..... Um lets see, if you don't see p waves, (you didn't specify) and this person was 70 years or older, and was wheezing, yes I would give adenosine. Only, if you can answer (correctly) this rational, please reply, if not, don't waste my time!!!)

[AZCEP]

With a rate of 150, the lack of P-waves should indicate several different rhythms that would not respond adequately to Adenosine.

The CAUSE of the tachycardia needs to be considered, not the treatment that will not have a favorable outcome to your patient.