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A bedside cardiac ultrasound was normal. The P wave is positive in lead aVL of ECG #3, which means it is a low atrial (or probably coronary sinus) rhythm — which of itself is not necessarily “abnormal” in a child if there is no other sign of underlying heartdisease. His chest was tender. He wrote: "ECG 1 - shows wide ???IVCD
Smith comment: This patient did not have a bedside ultrasound. Had one been done, it would have shown a feature that is apparent on this ultrasound (however, this patient's LV function would not be as good as in this clip): This is recorded with the LV on the right. In fact, bedside ultrasound might even find severe aortic stenosis.
Pads were placed with ultrasound guidance, so they were in the correct position. If you don't know what the dysrhythmia is, then try procainamide. If it is VT, adenosine is safe but not effective. Shocked x 2 without effect. What to do now? If you believe it is SVT, then try adenosine.
At first glance, the subject of heartdisease can seem exceptionally complex – consisting of several different conditions, medical jargon and very scary sounding terminology. As the heart becomes more muscular, it becomes stiffer and therefore does not fill with as much blood and therefore pumps less blood out.
Check : [vitals, SOB, Chest Pain, Ultrasound] If the patient has Abdominal Pain, Chest Pain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). heart auscultation (aortic stenosis); c. h/o heartdisease (+1) 3. orthostatic vitals b.
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