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i don't know where to begin, as far as i am concerned he should have been left alone, there is no clinical indication to do anything "to him" (words chosen specifically), 25y/old, ? chest pain and palps, no sign PMHx, ? FHx SVT, his BP is >90/60 and although I never go by BP readings as absolutes he apparently has no difficulty with mental status, no apparent/reported S+S CHF, no distress, etc, the ED MD should not have chewed out the crew, he should have chewed out the med con MD, unless there is other data we have not been privy to as yet in this case my answer to the first question "what would you have done" = Nothing the second question "what is the underlying rhythm" = broadly SVT, ie, ST/PAT, etc (I can't get the picture to enlarge to get a better look at the p, pr, breaks in rhythm, etc when I am able to I will comment further (a 3 lead 30sec RS done at 50mm/sec ( LapLand standard 
) and 20mm/mV would be helpful in these types of cases, we had a lengthy discussion a few months ago about the danger of the EMS mindset of "doing something" when at times the best thing to do is to do nothing (Primum Non Nocere), there was no mention of frequency of prior events if any, any possible precipitating events, ie, exercise, illicit drugs, meds, OTC meds, etc, any thought to CSM/valsalva/cool cloth to eyes to try to break, even if just for dx purposes, ? any thought to Ca+ blockers, B+ blockers, adenosine, ..., seems to me in this case a Howitzer was chosen (amiodarone) when a BB gun or nothing would do for now, ?? am I missing something here, good case for discussion,
) and 20mm/mV would be helpful in these types of cases, we had a lengthy discussion a few months ago about the danger of the EMS mindset of "doing something" when at times the best thing to do is to do nothing (Primum Non Nocere), there was no mention of frequency of prior events if any, any possible precipitating events, ie, exercise, illicit drugs, meds, OTC meds, etc, any thought to CSM/valsalva/cool cloth to eyes to try to break, even if just for dx purposes, ? any thought to Ca+ blockers, B+ blockers, adenosine, ..., seems to me in this case a Howitzer was chosen (amiodarone) when a BB gun or nothing would do for now, ?? am I missing something here, good case for discussion,Paul (PM)
Paul A. Matera, MD, EMTP
Clinical Associate Professor - George Washington University, D.C.
Director Emeritus - Critical Care Units, Providence Hospital, D.C.
Clinical Associate Professor - George Washington University, D.C.
Director Emeritus - Critical Care Units, Providence Hospital, D.C.
In a message dated 7/10/2009 10:17:36 A.M. Eastern Daylight Time, monseyman@... writes:
[Attachment(s) from MonseyMan included below]
A 25 y/o/m presented with some non-specific c/p and palpitations no prev med hx. Family hx of SVT.b/p was initially 110/70 then 100/60medical control gave orders for Amiodarone. The rhythm broke see attached.MD at ED chewed out the crew for giving amio - said he now has no options for pt and there is a liver toxicity issue etc.What would you have done? What is the underlying rhythm?Thank you all.
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