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I find AV dissociation in VT to be very difficult to differentiate from artifact, as there are always random blips on tachycardia tracings. 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. Ken notes AV dissociation. What to do now?
Bedside cardiac ultrasound showed moderately decreased LV function. Because she has cardiomyopathy and ventricular dysrhythmias, the pacer included an Implanted Cardioverter-Defibrillator (ICD) Echo 6 days later after CRT: Normal estimated left ventricular ejection fraction. Even with tachycardia and a paced QRS duration of ~0.16
Interpretation: There is sinus tachycardia, with right bundle branch block (RBBB). Blunt cardiac injury my result in : 1) Acute myocardial rupture with tamponade 2) Valve rupture (tricuspid, aortic, mitral) 3) Coronary thrombosis or dissection (and thus Acute MI) from direct coronary blunt injury 4) Dysrhythmias of all kinds.
Cardiac Ultrasound may be a surprisingly easy way to help make the diagnosis Answer: pulmonary embolism. Now another, with ultrasound. Then there is loss of pulses with continued narrow complex on the monitor ("PEA arrest") Learning Points: Sudden witnessed Cardiac Arrest due to ACS is almost always due to dysrhythmia.
Is it ventricular tachycardia (VT) due to hyperK or is it a supraventricular rhythm with hyperK? On arrival, the patient was in shock, was intubated, and had an immediate cardiac ultrasound. What does a heart look like on ultrasound when the EKG looks like that? They transported to the ED. How would you treat?
Bedside ultrasound showed no effusion and moderately decreased LV function, with B-lines of pulmonary edema. See here for management of Polymorphic Ventricular Tachycardia , which includes Torsades. Could the dysrhythmias have been prevented? He was managed medically with Clopidogrel. He appeared to be in shock.
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.
Here was his ED ECG: There is sinus tachycardia (rate about 114) with nonspecific ST-T abnormalities. A bedside POC cardiac ultrasound was done: Findings: Decreased left ventricular systolic function. An ECG was recorded: This shows a regular narrow complex tachycardia at a rate of about 160. BP:143/99, Pulse 109, Temp 37.2 °C
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). Most physicians will automatically be worried about these symptoms. Good History and Physical exam, including a.
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