speedygodzilla Posted May 19, 2007 Share Posted May 19, 2007 I smell a cookbook..... :roll: I am really confused on what needs to be rationaled. I am a basic but was taught that for a NRB mask the highest lpm of O2 is 15LPM. Since the patient is breathing more than 28 breaths per minute you may need to assist ventilations in order to ensure that they are good breaths. In the scenario scope2776 says that "pt on 15 LPM NRB" so what is the confusion? I am a newbie, but I pretty sure I know enough about airway and breathing on the basic level. Not knowing much about dx I would just have a feeling that drugs could be involved. I have only run one call with heart rate that high and it was drug related. Ask if she a drug abuser or is on a drug or drugs, been around someone that could of given her any drugs. It could also be a prescribe medication. Just a hunch. It is best to ask the patient in private and not around that trusty cop, as we are there for the health of the patient not justice. Link to comment Share on other sites More sharing options...
Imagine89 Posted May 19, 2007 Share Posted May 19, 2007 Is that rhythm SVT? I was assuming so, b/c someone mentioned it was. Is there then a narrow complex tachycardia within that rhythm or are they the same thing? LA is working on getting cardioversion (we'rer way behind in the times)...but for now I've seen adenosine correct SVT everytime it's been used...immediately. Adenosine will probably correct the problem if it is SVT. I have seen it work multiple times, and that is often the script if this is a recurring problem, however it is a very dangerous drug. You run a huge risk administering this medication. I thought that it should be administered as well, but since I don't know how to read the ECG, I was apparently missing something. "In individuals suspected of suffering from a supraventricular tachycardia (SVT), adenosine is used to help identify the rhythm. Certain SVTs can be successfully terminated with adenosine. This includes any re-entrant arrhythmias that require the AV node for the re-entry (e.g., AV reentrant tachycardia (AVRT), AV nodal reentrant tachycardia (AVNRT). In addition, atrial tachycardia can sometimes be terminated with adenosine. Adenosine has an indirect effect on atrial tissue causing a shortening of the refractory period. When administered via a central lumen catheter, adenosine has been shown to initiate atrial fibrillation because of its effect on atrial tissue. In individuals with accessory pathways, the onset of atrial fibrillation can lead to a life threatening ventricular fibrillation." Link to comment Share on other sites More sharing options...
AZCEP Posted May 19, 2007 Share Posted May 19, 2007 I will guess that you have gotten the idea of Adenosine being dangerous from the description you quote. Truth be told, it is probably the safest medication to use for a tachydysrhythmia that is commonly available. It's effects are self-limiting due to it's extremely short half-life. Take a moment to look at the strip, then look for an image of ventricular tachycardia. You will notice that they are very similar. This patient still requires immediate rhythm conversion, and not a medication. Link to comment Share on other sites More sharing options...
ericenglund Posted May 20, 2007 Share Posted May 20, 2007 I'd call that VT 8 days out of the week. I don't see where all this SVT and adenosine talk is coming from. Link to comment Share on other sites More sharing options...
mediccjh Posted May 20, 2007 Share Posted May 20, 2007 I would need to see a clearer picture of the 12-Lead EKG. It looks like there may be a BBB there; however the quality of the 12-Lead prohibits me from seeing it. Either way, she needs synchronized cardioversion. Start at 100J. And give the nurse a lesson in reading EKGs. Link to comment Share on other sites More sharing options...
Dustdevil Posted May 20, 2007 Share Posted May 20, 2007 I am really confused on what needs to be rationaled. I am a basic but was taught that for a NRB mask the highest lpm of O2 is 15LPM. Since the patient is breathing more than 28 breaths per minute you may need to assist ventilations in order to ensure that they are good breaths. In the scenario scope2776 says that "pt on 15 LPM NRB" so what is the confusion? I am a newbie, but I pretty sure I know enough about airway and breathing on the basic level. No offence intended, Speedy, but I believe that you just demonstrated that you actually know very little about airway and breathing on the basic level. I can assure you that there is not the slightest chance in hell that you know "enough" about it on any level. Not knowing enough is not a sin. It can be fixed. But thinking that you do know enough is a very dangerous thing. Close to being a sin. Link to comment Share on other sites More sharing options...
sladey67 Posted May 20, 2007 Share Posted May 20, 2007 I'd call that VT 8 days out of the week. I don't see where all this SVT and adenosine talk is coming from. Looks like VT to me too. Someone once told me ... "if it looks like VT it probably is" ... has held true in every case I've come accross. If it were me this chick is getting 100mg of lignocaine 2% iv. We don't cadiovert conscious pts. Link to comment Share on other sites More sharing options...
speedygodzilla Posted May 20, 2007 Share Posted May 20, 2007 No offence intended, Speedy, but I believe that you just demonstrated that you actually know very little about airway and breathing on the basic level. I can assure you that there is not the slightest chance in hell that you know "enough" about it on any level. Not knowing enough is not a sin. It can be fixed. But thinking that you do know enough is a very dangerous thing. Close to being a sin. I'm still confused. Please tell me what needed rationale. Is it because that was all I include in my short message. Please rationale this. "But thinking that you do know enough is very dangerous thing." You don't know me but I am a very persistent student. I try to learn as much as possible. I strive to know as much and definitely enough before I go out and serve the public. If I did not at least think that I knew enough at the basic level I believe that would be dangerous and I don't want to be a danger to a single patient. Lack of knowledge of your standard of care is dangerous to the patient. Link to comment Share on other sites More sharing options...
p3medic Posted May 20, 2007 Share Posted May 20, 2007 while the 5 differentials for this rythm is 1. VT, 2. VT, 3.VT, 4.VT 5. SVT with abberancy, the girls is young, no pmh, rate is very fast, faster than "most" VT's, has a LBBB looking pattern, and in my opinion in this internet senario is MOST likely svt....quite possible wpw that has yet been dx. I don't believe its a TCA OD, and tx the VT option is certainly the safest approach, as I stated when i made my intial impression that the origin of the arrythmia was semantics, the tx (electricity) is the same...I might, given an actual patient in front of me with ekg in hand, make the working dx of svt, and tx with a single 6mg dose of adenosine, it would be acceptable for were I work, however may be going way out on a limb for others....just my opinion. when in doubt, VT is your best choice. Link to comment Share on other sites More sharing options...
brock8024 Posted May 21, 2007 Share Posted May 21, 2007 Looks like VT to me too. Someone once told me ... "if it looks like VT it probably is" ... has held true in every case I've come accross. If it were me this chick is getting 100mg of lignocaine 2% iv. We don't cadiovert conscious pts. Why not cardiovert consious pts?? I was taught that you could give 5 mg of valium if needed. In this case her LOC is going down fast enough that she needs to be fixed now. I say forget the 5 mg of valium cardiovert here and then give it if needed. why wait til she codes on you or goes fully unconscious??? Link to comment Share on other sites More sharing options...
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