question for all the medical people out here. . .

[mutumbo]

ran into an interesting scneario the other day, that frankly has me confused.
i ran a code the other day, and our pt wound up with a pulse on the monitor of 150, with a wide complex, but a mechnical of about 50. since we had not given an antidysrhythmic we gave a lidocaine bolus, and then hung a drip of 1 mg/min. (as per our protocol)
my question is if you have a pt who is in symptomatic bigeminy or trigeminy, how do you treat this? i have one response that says go with the monitor and use lidocaine to slow the ventricular rhythm so that the SA node can take over again . . . . or what?


the reason im posting this here, is because i have no other ideas on where to look. im hoping SOMEONE can clear this whole thing up for me. thanks guys :)

[DefensiveCarry.com]

[Hopyard]

ran into an interesting scneario the other day, that frankly has me confused.
i ran a code the other day, and our pt wound up with a pulse on the monitor of 150, with a wide complex, but a mechnical of about 50. since we had not given an antidysrhythmic we gave a lidocaine bolus, and then hung a drip of 1 mg/min. (as per our protocol)
my question is if you have a pt who is in symptomatic bigeminy or trigeminy, how do you treat this? i have one response that says go with the monitor and use lidocaine to slow the ventricular rhythm so that the SA node can take over again . . . . or what?


the reason im posting this here, is because i have no other ideas on where to look. im hoping SOMEONE can clear this whole thing up for me. thanks guys :)

I'm not a physician and don't know some of the jargon you are using.
Do you mean by wide complex a widening of the qrs wave? Do you mean by "mechanical" the actual pulse rate was 50?

Are you talking about a patient with atrial bi/trigeminy that is not propagated to the ventricle--so there are slow ventricular contractions?

Or, am I completely not understanding the scenario?

I'm asking out of curiosity as an old physiologist of sorts.

[mutumbo]

I'm not a physician and don't know some of the jargon you are using.
Do you mean by wide complex a widening of the qrs wave? Do you mean by "mechanical" the actual pulse rate was 50?

Are you talking about a patient with atrial bi/trigeminy that is not propagated to the ventricle--so there are slow ventricular contractions?

Or, am I completely not understanding the scenario?

I'm asking out of curiosity as an old physiologist of sorts.

not a widening, per se, but a wide QRS complex.
and the bigeminy/trigeminy is a fast ventricular contraction that dosent originate where it is supposed to and is not really doing the body any good. does that make any sense?

and yes the mechanical pulse is the pulse you can feel :)

[SIXTO]

I'll ask my wife to read this if she comes back down stairs, I'm sure she'll know the answer, she's pretty damn smart and knows what all that crap means.

[FloridaSon]

ran into an interesting scneario the other day, that frankly has me confused.
i ran a code the other day, and our pt wound up with a pulse on the monitor of 150, with a wide complex, but a mechnical of about 50. since we had not given an antidysrhythmic we gave a lidocaine bolus, and then hung a drip of 1 mg/min. (as per our protocol)
my question is if you have a pt who is in symptomatic bigeminy or trigeminy, how do you treat this? i have one response that says go with the monitor and use lidocaine to slow the ventricular rhythm so that the SA node can take over again . . . . or what?


the reason im posting this here, is because i have no other ideas on where to look. im hoping SOMEONE can clear this whole thing up for me. thanks guys :)

Hmmmm. Have you asked your medical director?
Have you checked Tier I AHA guidelines against your protocol?
Have you asked your system's EMS supervisor?
Have you asked a more experience medic?
Are you considering this VT?
Polymorphic (Torsades?) or monomorphic?
Some may say amiodorone or mag. In clinical setting depending on underlying cause, ablation?
I am not sure why you would post this ? on this forum.
We cannot treat a pt on a forum without the rest of the story.
You can alway email Bledsoe from Jems.

[xchief1]

ditto

[rocky]

Wow, talk about off topic. While you are at it can you find out the meaning of life for us and why the sky is blue? thanks.

[randy7601]

ran into an interesting scneario the other day, that frankly has me confused.
i ran a code the other day, and our pt wound up with a pulse on the monitor of 150, with a wide complex, but a mechnical of about 50. since we had not given an antidysrhythmic we gave a lidocaine bolus, and then hung a drip of 1 mg/min. (as per our protocol)
my question is if you have a pt who is in symptomatic bigeminy or trigeminy, how do you treat this? i have one response that says go with the monitor and use lidocaine to slow the ventricular rhythm so that the SA node can take over again . . . . or what?

What did we start with? What initiated the code? VF/VT? SVT? Brady? HTN? HypoTN?

[cdjspider]

Wow, talk about off topic. While you are at it can you find out the meaning of life for us and why the sky is blue? thanks.

Dunno about the meaning of life, maybe collect as many cool guns as you can before you die?

Sky is blue:

The sunlit sky appears blue because air scatters short-wavelength light more than longer wavelengths. Since blue light is at the short wavelength end of the visible spectrum, it is more strongly scattered in the atmosphere than long wavelength red light. The result is that the human eye perceives blue when looking toward parts of the sky other than the sun.[1] Near sunrise and sunset, most of the light we see comes in nearly tangent to the Earth's surface, so that the light's path through the atmosphere is so long that much of the blue and even green light is scattered out, leaving the sun rays and the clouds it illuminates red. Therefore, when looking at the sunset and sunrise, you will see the color red more than any of the other colors.

Scattering and absorption are major causes of the attenuation of radiation by the atmosphere. Scattering varies as a function of the ratio of the particle diameter to the wavelength of the radiation. When this ratio is less than about one-tenth, Rayleigh scattering occurs in which the scattering coefficient varies inversely as the fourth power of the wavelength. At larger values of the ratio of particle diameter to wavelength, the scattering varies in a complex fashion described, for spherical particles, by the Mie theory; at a ratio of the order of 10, the laws of geometric optics begin to apply.




Yeah, I'm that bored....

[Cupcake]

That is interesting...there are still other questions like how symptomatic is the PT (LOC, BP). Around where I've worked, we were rarely more than 20 minutes from an ER, often just 10. It's also usually not too difficult to get an ER Doc on the radio for further direction around here.

[Hopyard]

not a widening, per se, but a wide QRS complex.
and the bigeminy/trigeminy is a fast ventricular contraction that dosent originate where it is supposed to and is not really doing the body any good. does that make any sense?

and yes the mechanical pulse is the pulse you can feel :)

Help me understand please. Are you talking about ventricular contractions seen on the ECG at a rate of 150 but effective contractions measured by taking the pulse at a rate of 50?

That is, there is an initiation of the contraction occurring in the ventricle that doesn't result in an effective contraction? Is that what you are saying?

What are the atria doing? Are they responding to sinus node signals or are they off doing their own thing as well?

I'm just asking so I can better understand any responses you get from the real docs.

Thanks.

I thought Randy asked the right question, btw. "What did we start with? What initiated the code? VF/VT? SVT? Brady? HTN? HypoTN?"

[mutumbo]

Hmmmm. Have you asked your medical director?
Have you checked Tier I AHA guidelines against your protocol?
Have you asked your system's EMS supervisor?
Have you asked a more experience medic?
Are you considering this VT?
Polymorphic (Torsades?) or monomorphic?
Some may say amiodorone or mag. In clinical setting depending on underlying cause, ablation?
I am not sure why you would post this ? on this forum.
We cannot treat a pt on a forum without the rest of the story.
You can alway email Bledsoe from Jems.

asked a bunch of people today and they said go with lidocaine or amiodarone drips.

What did we start with? What initiated the code? VF/VT? SVT? Brady? HTN? HypoTN?

80 year old guy jsut fell over while eating dinner, wife was doing CPR we shocked him into asystole. then he went back into v fib, then shocked into asystole then a pulseless rhythm, then what i described :)

[mutumbo]

Help me understand please. Are you talking about ventricular contractions seen on the ECG at a rate of 150 but effective contractions measured by taking the pulse at a rate of 50?

That is, there is an initiation of the contraction occurring in the ventricle that doesn't result in an effective contraction? Is that what you are saying?

What are the atria doing? Are they responding to sinus node signals or are they off doing their own thing as well?

yes to the first part, that is exactly what is going on.

the second part, is also yes.

the third part, im pretty sure the atria are doing their own thing, but its just being coverd by the ventricular response, but im not 100%

[boricua]

Stabilize pt's ABCs and medevac to level III facility (Army medical jargon). My 2 cents...(you asked).

[schwaa]

How wide were your complexes? What was the response to your lido bolus/drip?

Blah, Amiodarone 150mg/100c 15gtts/25sec. Call the doc in the box. Why cant they just be epi/atropine, then come back to life and say "HEY! THANKS A BUNCH BUDDY!"