Case Study: Sepsis and Tachycardia (with EKGs)

[ExplorerShane]

No problem.

Just a suggestion, for simple terminology and basic procedures, google them first. Read up about it. Then if you have further questions, ask about it. Nothing wrong with asking questions at all. But reading up on something first, can help with the explanations further on, and also makes your questions seem more substantial.

Haha, sorry about that.

[ccmedoc]

We don't have an issue with going L+S to the hospital here. Everyone here is a paramedic of varying level. They have driver education, specific specialized licenses, etc... They don't drive L+S like idiots, the generalization being that your's do.

It is not my partners driving that bothers me with the L+S, it is the response of the other panicked drivers on the road..

Stroke patient only eh? Trauma, query MI, eminent pregnancy....

Pregnancy, not so much a priority---pre-term..maybe. Trauma with need for surgical intervention and some AMI patients, absolutely..most non-STEMI patients in our area do not go to cath lab, so why priority transport if suspected?? Most often the benefit is not worth the risk of a hot transport.

[firefighter523]

I think we have gotten off the beaten path. This rhythm is NOT SVT, it is sinus tach, there for Adenosine should not be given. Not even for diagnostic purposes,(in this case) there is nothing more to diagnose with this rhythm, you have 1 p wave to 1 qrs, the pr interval is consistent and wnl. And further more , I don't even think cardioversion would help this pt.

This rhythm is totally compensitory with the situation. People with sepsis die, and it just sucks that he or she was with you at the very end stages. We as providers medics, nurses,and docs can only do so much. I highly agree with AZCEP, fluids, fluids, and possibly pressors.

[fiznat]

This rhythm is NOT SVT, it is sinus tach, there for Adenosine should not be given.

Ugh, this is getting redundant.

Sinus tachycardia IS A TYPE OF SVT. Not to mention that this rhythm is not absolutely sinus tach. Sure, it probably is, but there DO exist other possibilities for which Adenosine/Cardioversion could have worked. We've discussed this, maybe 3 pages back.

If there is something new you would like to add, then please do.

[AZCEP]

When SVT is used to describe a rhythm with a clear origin, it shows the provider is not looking closely enough at the information in front of them. The strips you provided show a clear origin for the rhythm. Whether it is ectopic atrial tachycardia, or sinus, the treatment is still not goin to be Adenosine.

The argument for using Adenosine as a diagnostic aid is for those times that you can't clearly discern the origin of the rhythm. This patient has a clearly discernible origin. It is not atrial fibrillation, as there are clearly discernible P-waves. Atrial flutter, while being possible, is not a strong possibility due to the absence of the flutter wave moving through the rest of the cardiac cycle. The QRS isn't slurred on the upstroke or at the J-point. That eliminates the possibility of atrial flutter.

Yes, you were in a position that you needed to make a choice quickly on how to best manage this patient. Adenosine was not the decision that should have been made, and now you've learned that. Discussing the utility of "priority" transport is immaterial since we aren't familiar with any information that would make a difference in that decision. You got the patient to the hospital alive, and in no worse shape than when you made contact with them. You didn't cause another incident by transporting "priority", so there is really nothing more to argue with the hope of learning something from the incident.

Arguing minutae is a complete waste of effort.

[firefighter523]

Fiznat, everyone praises you for coming out [CONTENT REMOVED - ADMIN ]. I think that, if you think that you should cardiovert sinus tach, [CONTENT REMOVED - ADMIN ] Let me break it to you [CONTENT REMOVED - ADMIN ], if you see a p wave= NO CARDIOVERSION!! Does that equation make sense? There IS a p wave PERIOD!!! NOT SVT, PERIOD!!! NO ADENOSINE, PERIOD!!! If the doc, needs adenosine to see THAT p wave, that is just a waist of time!!! That is on him, NEVER give adenosine to sinus tach, PERIOD!!!

[fiznat]

Let me break it to you [CONTENT REMOVED - ADMIN ]...

I never said that I would have cardioverted, or even given Adenosine to sinus tach. It might help to read back on what has already been posted, over the last 4 pages, and see the discussion that took place about determination of the rhythm and use of the drug - as endorsed by our regular docs here - for a diagnostic purpose.

Thank you though, for your grandiose - albit repetitive and late - restatement of all that has already been said. The addition of your point of view was not only vital, but pivotal in the continuation of our discussion here. I was wondering if you could restate again: what is your position on adenosine and sinus tachycardia?

[mediccjh]

I never said that I would have cardioverted, or even given Adenosine to sinus tach. It might help to read back on what has already been posted, over the last 4 pages, and see the discussion that took place about determination of the rhythm and use of the drug - as endorsed by our regular docs here - for a diagnostic purpose.

Thank you though, for your grandiose - albit repetitive and late - restatement of all that has already been said.

[CONTENT REMOVED - ADMIN ]

(No disrespect intended to those that cross-dress and do both jobs well.)