EKG Interp/scenario take 2

tah06090

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here we go 72 yr old female c/c CP ems is bls. 12 lead is done transmitted shows ST elevation II,III, avf with reciprocal changes laterally, 5 min from hospital pt has arrest cpr and defib x1 this is the 12 lead as shes being rolled in the ED

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18G

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An elderly female with CP and 12-lead showing inferior MI will get the standard ACS tx, cath lab alert, and if arrested standard ACLS.
 
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tah06090

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no prehospital EKG pt was on continuous 12 lead she stated i dont feel right this is what the second 12 lead looked like

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rhan101277

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Vtach w/ pulses? If stable try amiodarone 150mg over 10 mins, then maintenance infusion.

If she goes unstable then sync cardiovert.
 

socalmedic

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I would not call that V-tach. looks like V-fib to me. to the OP i dont understand what you are getting at. is there a question or is this just an FYI.
 

Hockey

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I would not call that V-tach. looks like V-fib to me. to the OP i dont understand what you are getting at. is there a question or is this just an FYI.

This.


V-fib. Shock, CPR and all the goodies. Not vtach. But does it even matter
 

MrBrown

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First ECG looks like some sort of wicked bundle branch block or hyperkalemia

Second is either diagnostic mode VF or it's VT

If its VT Brown would cardiovert first and ask questions or hang amiodarone later
 

CANMAN

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This.


V-fib. Shock, CPR and all the goodies. Not vtach. But does it even matter


Ummmm the second 12 lead is clearly V-Fib, anyone who disagrees needs to repeat P-school. As far as treatment modalities it certainly matter's if it was V-tac vs. V-fib, you could have a stable V-tac with pulses thus requiring no defib :rolleyes:
 

Hockey

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Ummmm the second 12 lead is clearly V-Fib, anyone who disagrees needs to repeat P-school. As far as treatment modalities it certainly matter's if it was V-tac vs. V-fib, you could have a stable V-tac with pulses thus requiring no defib :rolleyes:


Actually I thought I read somewhere that they went unresponsive and had no pulse. But then again I was 4 sheets to the wind last night as well
 

CANMAN

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Damm 4 sheets to the wind, you treatments are still fairly on point :beerchug:
 

18G

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I am confused by the whole scenerio. The first ECG posted and description given makes it sound like that ECG is post-arrest. Did u get the ECG's mixed up when u posted em?

The second one is definitly vfib. If the pt. had a pulse with vfib then she had a LVAD.
 

8jimi8

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I thought lvad doesn't have a palpable pulse??
 

reaper

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Most won't have a palpable pulse. But you would have to be blind, to not see an LVAD on them.
 

Aidey

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The second one is definitly vfib. If the pt. had a pulse with vfib then she had a LVAD.

Huh? That doesn't make any sense.

I thought lvad doesn't have a palpable pulse??

Usually not, but there are some people with the older pulsating types that do have a "pulse".
 

18G

Paramedic
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Aidy... ur right... that does not make ne sense... lol. I am well into a 44hr shift and spewed that out without thinking much abt it. It is def vfib but the LVAD comment is not correct. As mentioned most pts with LVAD dont have a pulse or one that is severely diminished. It is possible however, that a pt with a LVAD can have vfib and be walking and talking. I think that is where my comment evolved from.
 
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tah06090

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Ok to clear things up the first ECG is post arrest but the patient woke up aftter first defib and the second ECG is when she arrested again. This was just a interesting case i was sharing considering the patient kept waking up i have 2 more ECGs from this case to post, so patient was defib again and woke up heres what the 3rd ECG looks like pt was also given TNK at this point



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Hockey

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Ok to clear things up the first ECG is post arrest but the patient woke up aftter first defib and the second ECG is when she arrested again. This was just a interesting case i was sharing considering the patient kept waking up i have 2 more ECGs from this case to post, so patient was defib again and woke up heres what the 3rd ECG looks like pt was also given TNK at this point



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And that is Vtach.
 

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