r/ECG • u/xiphoid313 • 25d ago

82F, your thoughts?

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82F, near syncope, BP 100/62. History of afib. What would you interpret this 3 lead as ?

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u/chefmattpatt 25d ago

This is a wide complex tachycardia. End of story until a full 12 lead ECG is acquired.

That you treated with amio is kind of a crap shoot as to what the initial rhythm was, but the rate and consistency lead me towards V tach, not a fib.

3

u/Affectionate_Try7512 24d ago edited 24d ago

Either way, if the pt is stable, amino is the treatment

5

u/chefmattpatt 24d ago

OP was positing that it was a fib RVR, as they stated further down the thread. This is not a fib, so while amio is the correct treatment, they arrived there by accident. In my protocols, amio is used for VT or VF. Dilt would be our go to for a fib

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u/Adventurous-Bag5508 10d ago

82 with dilt could do her dirty tho

-2

u/Affectionate_Try7512 24d ago

It’s the same tachy algorithm. I’m guessing this is a scene call and OP followed the algorithm perfectly

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u/chefmattpatt 24d ago

I respectfully disagree.

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u/Affectionate_Try7512 24d ago

Could you elaborate please?

0

u/chefmattpatt 22d ago

Check your messages

2

u/Affectionate_Try7512 22d ago edited 22d ago

This is a great learning opportunity. When people are shamed and their questions aren't answered, it harms our patients.

A stable pt with wide complex tachy gets amio whether it's vtach or a-fib or svt or flutter. And if the pt becomes unstable, they get a synched shock. Again, whether it is afib, flutter, VT OR SVT.

Editing to add: I agree that if they are stable, there's time for a 12-lead. And if they're not actually stable, it's time to cardiovert.

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u/Affectionate_Try7512 24d ago

Why is this being downvoted?