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Hmm. Now I think this patient needs to goto the EP lab then get the ablation done :P
Besides that I do feel that there are p waves and I feel it is regular, maybe junctional hard to tell at that speed. A trial of cardizem would be an option I think. If that didn't work move on to amiodarone 150. If we don't think this is WPW for sure then there is always Dig. Seems to me though that since the patient is already on amidoarone it might be the next best thing.
That is just a shot in the dark.
mike
---- Original Message -----
From: Nick NudellSent: Monday, September 01, 2003 2:14 AMSubject: [ekg_club] September Case ReviewOk, I am wasting no time here... hot off the press with this case!A 63 year old female presents with palpitations, sudden onset about two hours prior to arrival at the ED. She has had three previous episodes, all converting with Adenosine 6mgs. The most recent conversion occurred less then 12 hours prior, in this same ED. The nurses involved previously were still working but did not get the patient for this assignment and did not know of her presence until later.The patient has NKDA. Current meds are: Amiodarone, lipitor and Phenobarbital. The amiodarone was started after the first occurrence about three months ago. Past medical history is listed as: hypercholesterolemia, PSVT, seizures, and WPW.On assessment the patient is A&Ox4, in no apparent distress. Has no complaints of CP or SOB. Radial pulses are weak, regular and rapid. Respiratory exam is normal. The patient ambulates without difficulty. The labs come back (later, after treatment) as:all WNL except for MCH 32.6 (H)%Neuts 79.7 (H)%Lymphs 11.3 (L)Glucose 115 (H)Creatinine 1.1 (H)The AMI panel comes back:CK/CPK 72 (WNL)CK-MB 0.0 (WNL)CK-MB Index 0.0 (WNL)Troponin-I 0.08 (WNL)Myoglobin 28 (WNL)A mag level is checked:Magnesium 2.1 (WNL)The vitals on triage are: T36.7, HR 189, RR 19, BP 175/109, Pain 0/10. SpO2 97% on RA.Attached are the initial rhythm strips and 12 lead EKG. What do you think about them?The computed measurements are:Vent Rate: 161PR Interval: *QRS Duration: 168 msQT/QTc: 300/491 msP-R-T axes: * -5 79The computed interpretation is:Wide QRS TachycardiaLeft ventricular hypertrophy with QRS widening and repolorization abnormalityAbnormal EKG.What treatment would you provide based on the above information? I will follow this up with what we did and the outcomes...Nick"Perception is reality" - Wise Old Paramedic
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