scope2776 Posted April 21, 2007 Share Posted April 21, 2007 Pretty straight forward. Let's hear what you think! Apologize for the image quality.... Bonus for treatment plans.... Link to comment Share on other sites More sharing options...
ERDoc Posted April 21, 2007 Share Posted April 21, 2007 Pretty straight forward. Let's hear what you think! Apologize for the image quality.... Bonus for treatment plans.... NSR with some J point elevation. :wink: GI cocktail and go home. Link to comment Share on other sites More sharing options...
AZCEP Posted April 21, 2007 Share Posted April 21, 2007 If you want a treatment plan, you will have to provide more than a 12 lead. Sinus tachycardia, fluid bolus for the dehydration then send them home. Link to comment Share on other sites More sharing options...
scratrat Posted April 21, 2007 Share Posted April 21, 2007 Next time block out the interpretation so those who are learning can investigate it on their own. Just saying. It's a BBB. So everything else is out the window. Treatment. I need a complaint first. CP? Fever? SOB? Dizziness? ????? And how did you get that 12 lead up there? Scan it and add it as JPG file? That's pretty cool. Link to comment Share on other sites More sharing options...
JCicco345 Posted April 21, 2007 Share Posted April 21, 2007 As was mentioned above it is sinus tach with a LBBB. Any treatment to this patient would be strictly related to signs and symptoms as opposed to the rhythm. Probably just start a line and give some fluid. Link to comment Share on other sites More sharing options...
JCicco345 Posted April 21, 2007 Share Posted April 21, 2007 As was mentioned above it is sinus tach with a LBBB. Any treatment to this patient would be strictly related to signs and symptoms as opposed to the rhythm. Probably just start a line and give some fluid. Link to comment Share on other sites More sharing options...
scratrat Posted April 22, 2007 Share Posted April 22, 2007 I can't agree with any treatment as of yet. Especially not fluid challenges. What if it's tachy because they are infarcting c/ normotension? Or BBB is normal but they are in CHF hence the heart rate? Or something as simple as fever? I don't think I can commit to treatment modalities without hearing some sort of patient information. Link to comment Share on other sites More sharing options...
njmedic1485 Posted April 22, 2007 Share Posted April 22, 2007 As others have said the story will direct the treatment, but don't forget that New LBBB in an indication for PCI. So what's the story behind the 12 lead? Link to comment Share on other sites More sharing options...
scope2776 Posted April 23, 2007 Author Share Posted April 23, 2007 There's really no story on this one, I think I got it from class. Just going through the butterfly collection and thought I'd share. I didn't black out the machine interpretation because, as most of you probably know - and if you're new you should find out - those interpretations are not always accurate. Usually I disregard them all together. I have a great strip that illustrates this... just how wacky the interps can be... i'll try and post it. This is indeed sinus tach with a LBBB. The ST elevation is characteristic of a LBBB. There are however a couple of premature beats (beats 3 and and 3rd from the right). I think they are either PVCs or PACs, I think those are P waves... i dunno. Based solely on this 12-lead I was looking for treatments for ischemia... Even if my patient was asymptomatic, i'm still going to give 324mg ASA and maybe some nitro (pressure depending) and you bet you socks O2. This is a very concerning ECG, a ischemic heart beating fast, throwing premature beats. I would also wager on an underlying MI. Thanks for the comments! Link to comment Share on other sites More sharing options...
scratrat Posted April 23, 2007 Share Posted April 23, 2007 ST Elevation is NOT indicative of LBB and that's is not how you figure it out. The ST segment changes are possibly caused by it, but that's not how you determine if it is a BBB. Look at the QRS complex. If it looks wide, immediately go to V1. If the QRS is greater than 0.10 (and I think AHA may have raised it to 0.12), it's a BBB. Now looking at V1, go backwards from the T wave. If the QRS complex is negatively deflected, it's a LBBB. If it's positively deflected in V1, it's a RBBB. And about your treatment modality, slow down there trigger. I may be looking for answers as to the cause, but if the pt is asymptomatic, I would most definitely NOT be arbitrarily throwing NTG and ASA his way. It could be indicative of an infarct, in which case go for it. But it may also be normal for that pt. Remember to ask the pt if they know they have it, or if they have an old ECG. I can't stress this enough (sorry for shouting) TREAT YOUR PT NOT YOUR MACHINE!!!!! Link to comment Share on other sites More sharing options...
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