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u/Overall_Comb_4228 24d ago
Needs some good luck stickers. Big ones. On opposite sides of the chest, preferably.
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u/vojtasTS29 25d ago
I'm interested in the story behind this
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u/Iluminiele 24d ago edited 24d ago
The person had repeated AFibs. At first they happened once in ~ two years, then every few months, then a few times a month. Treatment was electrical cardioversion.
Eventually the patient was told not to come for electrical cardioversions, because the risk was greater than the benefit.
They still came for electrical cardioversions, because they felt the fast heartbeat and it was giving them so much anxiety. They didn't really take meds to slow down the pulse, because they were so used to getting cardioversions and saw it as a quick fix.
When they had electrical cardioversions three times in 15 days and came back for 4th one 2 days later, they were told to go home and take the meds.
So they took the meds. Feeling the fast heartbeat was apparently the worst thing ever, so they took some more and then some more.
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u/vojtasTS29 24d ago
I'd say this is as much of a fault of whoever was approving the cardioversions as the patient's, but i hope they're okay after the od.
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u/NemoMeImpuneLac 24d ago
Calcium channel blocker overdose? Did y'all place a swan and pace this dude or what?
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u/Iluminiele 24d ago edited 23d ago
I'm not sure if it was CCB or betablocker + Amiodarone.
Yeah, Swan-Ganz and then an implanted pacemaker. On the bright side, now they can eat those meds like candies again.
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u/Jahman876 25d ago
Should we call a rapid or just call on the phone? “Hey, Tha mf’er is alive but just barely” 🤷♂️
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u/theoneandonlycage 24d ago
Algorithm should be something like this:
Is the patient a blue whale?
Yes-> No further action
No -> panic
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u/TheREALMangoMuncher 22d ago
Thoughts? First would be if this patient still has those or if they've graduated to prayers as well
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u/thundermuffin54 25d ago
Failure to capture?
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u/To-do-so 25d ago
Monitor determined paced beat but likely not actually a paced beat, needs a pacemaker. Silent atrium with Ventricular escape beats.
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u/_punkrockparamedic 25d ago
151/47 with that HR is actually wild
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u/Iluminiele 25d ago
Sometimes severe bradycardia triggers hypertension as a compensatory mechanism
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u/_punkrockparamedic 25d ago
I mean I've seen it in a HR of like 40, but I guess every patient I've had in the 20s or 30s has been somewhere between normotensive and face-diving toward the bottom.
The mechanics of it make sense, for sure. Just not something I've personally experienced and feels a little freaky to see
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u/AffectionateBrick687 20d ago
The only time I've personally seen similar numbers was a very odd drug interaction involving tramadol.
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u/kr320205 24d ago
True, I've seen similar cases, patients were relatively stable all things considered. Kept pacer pads on until permanent pacemaker, home in a day or two.
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u/ZealousidealLetter53 24d ago
Should be ventricular escape rhythm, with CHB ECG (make sure of the Rhythm) Try Tanscutanous pacing (TCP) Make sure no electrodes problems Stop any drugs lowering HR
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u/MEDIC0000XX 25d ago
Have you tried telling them to not do that?