Complex cardioversion?

[medic001918]

If you give CCB to a reg SVT it could have disasterous effects.

Are you 100% positive of that? Some doc's that I've talked to are starting to use Cardizem to treat SVT's instead of adenosine. In fact, I have cardizem in my protocol for an SVT that is refractory to adenosine. And that's on standing orders.

Here's a link to the protocols if you'd like to read up on it yourself for verficiation: http://www.northcentralctems.org/June%2020...otcolsfinal.pdf

And here's some more reading for you before any more incorrect information gets spread around.

http://www.ionchannels.org/showabstract.php?pmid=11841884 This article states "CONCLUSION: Calcium channel blockers infusions were safe and efficacious in terminating spontaneous SVT."

http://www.emedicine.com/med/topic1762.htm This article states "Other alternatives for the acute treatment of SVT include calcium channel blockers like verapamil, diltiazem or beta-blockers like metoprolol or esmolol. Verapamil is a calcium channel blocker that also has AV blocking properties. Verapamil has a longer half-life than adenosine and may help maintain sinus rhythm following the termination of SVT. It is also advantageous for controlling the ventricular rate in patients with atrial tachyarrhythmia (Ganz, 1995; Campbell, 1997; Connors, 1997; Levy, 1997; Xie, 1998; Gold, 1999; Siberry, 2000; Josephson, 2001)."

So, as much as I tried, I can't find any information that agrees with your statement about "disasterous effects" when using a CCB in the presence of an SVT.

Shane

NREMT-P

[Thunderchild145]

Yea, we have the same protocols. Diltiazem or verapamil for SVT if Adenosine fails to convert and the patient remains stable. But we give diltiazem or verapamil for A-fib frequently when they are borderline-stable lik this guy. Obviously, he's not entirely stable, but I would use drugs to try and slow him down, not electricity.

[firefighter523]

Medic 001, sorry about that, we have the same protocols for SVT, disasterous effects only due to the hypotension and CHF, and cardiogenic shock that this pt is presenting with.

[ERDoc]

Medic 001, sorry about that, we have the same protocols for SVT, disasterous effects only due to the hypotension and CHF, and cardiogenic shock that this pt is presenting with.

I can't believe I'm going here again. :banghead: Newbie, you continue to flip flop. I am really begining to agree with the others that you are a new medic with an ego that exceeds your knowledge, especially since you continue to fail to list your experience. Based on your posts you seem to have little field experience but can quote a book like a freshman premed. You have said in the past that we need to control the rhythm. Not exactly, what we need to control is the rate. This can be accomplished with cardizem. You will not have any disasterous effects that you seem to be concerned with. As you have said all of the symptoms are associated with the rate. If you control the rate and allow more filling time, you will improve the BP, so the hypotension will not be an issue. This is not true CHF, since as you have said the fluid buildup is from the rate. This also does not fit the definition of cardiogenic shock. To be in cardiogenic shock you need to have a sustained hypotension, inadequate tissue perfusion and adequate LV filling pressure. This pt lacks the LV pressure sp he cannot be described as being in cardiogenic shock. If you truly feel that this pt is in cardiogenic shock, why have you not started him on Dobutamine?

I will ask again for all of those involved, what is your level of education and field experience? :banghead:

[Ridryder 911]

Aww Doc it appears he has a B.S. degree from Google, or he has to go run to his partner on how to answer. Say a prayer for his crew and especially for his patient's sake....The same reason he keeps flip flopping is because he does not understand simplistic cardiac physiology or cardiac care more than what is on a ACLS card. Thus the reason of avoidance of credentials as well. This is would be quite humorous, but I am afraid ths person is serious.

Here F/f 523 this book might assist you :

[web:b9d642b0b2]http://www.amazon.com/Cardiology-Explained-Remedica/dp/1901346226[/web:b9d642b0b2]

[Just Plain Ruff]

I know I'm gonna catch hell for this as well as may get booted but I don't really care right now. here is the text of a pm that fire sent me. Again with the insults and personal assault

text begins here

Removed at the request of the poster - Admin TEXT ENDS here

Ban me if you want but this had to be posted. Insults and not a bit of constructive criticism. this also shows this yahoo's disdain for all of us on this site.

[ERDoc]

A little EBM for those who are interested and FF523:

http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsum

http://www.ncbi.nlm.nih.gov/entrez/query.f...st_uids=7741343

FF523, if you want to have an intelligent debate, please refrain from the name calling and insulting, and as always please share your education and experience.

[Just Plain Ruff]

Fire, I believe you told Brock not to respond if he didn't have the correct answer.

You are like John Kerry and his flip flops on everything. The only two things you seem consistent in not flip flopping on is the fact that you insult every one of us. And second, you are firm in your belief that you cardiovert before correct the Airway and the breathing.

Insult us all you want and continue to believe that your way is the only way or take the highway. What frightens me is that you refuse to back up your claims that you are a medic.

Let me ask you this scenario

how would you treat a 6 year old pediatric patient with a tachy rate of 220 and resp rate of 66? Would you treat the rhythm or treat the airway issue?

I can't imagine that you would answer this question as you have not answered anyone elses question except with nasty replies.

[firefighter523]

Ruff, thank you for posting my reply in the general forum, I really wanted everyone to see it anyway, since it explaines the right treatment. Did you like the analogy about the nail in the foot? ER Doc, I understand that if you correct the (Rate) specifically it will increase ventricular filling time, hence increase cardiac output, BP, tissue perfussion. Unfortunately we only use Verapamil, and WILL NEVER get orders in the field unless out transport time is long and his BP is well over 100. They would rather us not give it in the field. We have not graduated to wonderful Cartizem yet.

Once again Ruff, my kids would go running to their friends like YOU did!!!! This bashing has actually gotten us off the beaten path about Rx modalities.... So to answer your question about the pedi pt. He or she would get high flow 02 (That is oxygenation and not airway) We will assume his airway is open since he is breathing that fast, K? He would get an IV, and up to 3 fluid boluses to equal 60cc's/kg, 30cc/kg if he was an infant. If his heart rate dipped below 100, he would get PPV at 1 breath every 3 secs, if his hr dipped below 80, and remained there for longer than 30 secs or more, or just plain dropped below 60, he would get chest compressions at 1 every 1 1/2 seconds. If his respiratory rate, and HR failed to rise with those efforts, he would get .01mg/kg of IV epi 1:10,000.

Now my friend........I have a question for you...... Tell me if you will, I answered your question, If you encounter a pt with malignant PVC's, (Closely coupled, multifocal, or in salvos, with assoc symptoms of CP, SOB, or hypotension what would you do! Tell me the pathology of giving lidocaine to a hypoxic heart !!!!

[Just Plain Ruff]

I'll answer like you have in the past

CARDIOVERT and thats all I'm gonna do. NO matter what anyone else tells me is the right treatment or a alternative treatment.

To begin with because I have a meeting in 5 minutes and I'll give you the rest later.

Airway - make sure clear and open

Breathing - assess and treat life threatening breathing problems.

Circulation - I'll address this in a subsequent post as the meeting is now starting.