ekg_club : Messages : 10653-10683 of 12616

Sorry I have been away over the weekend, I have posted a few more EKG's from this pt. at ekg.sytes.net. The ekg's are all from this pt.

This Pt.had stable vitals, throughout transport. We administered 150mg Amiodorone in 100cc D5W over 10 minutes. After arrival at the E.D. her pressure lowered to a systolic of 98.

The tachycardia did not break. Over a few hours the E.D. treated with cardizem, then dig & thinners. Eventually they were going to cardiovert, but she broke just before this as she went to the bathroom. She was then transfered to electro-physiology, at another facility. She had some sort of abblation on the third day. We have not yet had a report on what they actually did.

Dov Pincus

From: ekg_club@yahoogroups.com [mailto:ekg_club@yahoogroups.com] On Behalf Of wegandy1938@...
Sent: Saturday, November 01, 2008 1:47 AM
To: ekg_club@yahoogroups.com
Subject: Re: [ekg_club] 25 y/o Chest Discomfort

For some reason I did not get the strips. Could somebody send them to me?

Gene

#10682

From: wegandy1938@...
Date: Sat Nov 1, 2008 1:47 am
Subject: Re: 25 y/o Chest Discomfort

wegandy

Offline

For some reason I did not get the strips. Could somebody send them to me?

Gene
In a message dated 10/31/08 2:30:34 PM, tbouthillet@... writes:

Agree with AF/WPW. The only thing I'd like to add (since everything else has been said) is that you need to consider an accessory pathway when the shortest R-R interval is < or = than 6 small blocks. Also, when it's an irregular wide complex tachycardia without turning of the points. This is a patient you could harm (or kill) by giving drugs like calcium channel blockers for rate control. Great case! Would you mind scanning it again so we can see the GE/Marquette 12SL interpretive algorithm's take on it?

Just for fun!

Tom

On Fri, Oct 31, 2008 at 12:22 PM, <dov_pincus@...> wrote:

Hi all, I have been lurking and learning here for quite some time. Recently we had a Pt. that we could some expert consultations on .....

We were called by BLS at at 9am for a 25y/o female, at home c/o some slight chest discomfort x 1 hour. Her BP was 140/90, HR="fast and irregular", RR=20.

We found her sitting on a bed, Alert and oriented, and pale. She states that she was doing her normal morning chores around the house when she stared feeling some discomfort. Over a few years She has had this feeling a few times, but it always went away after a few minutes. Her doctors never found anything noteworthy. This time it is already an hour and it has not stopped. She denies any history, or Allergies, and is on Lo/Ovral.

We placed the monitor on her and found the ekg's tracings that are attached, runs of wide complex tachycardia increasing from a few beats at a time to runs that last over a minute. Pt presentation & vitals stable throughout.

Dov Pincus
EMT-P (NY)

**************
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#10681

From: "Tom Bouthillet" <tbouthillet@...>
Date: Fri Oct 31, 2008 9:28 pm
Subject: Re: 25 y/o Chest Discomfort

code3insc

Offline

On Fri, Oct 31, 2008 at 12:22 PM, <dov_pincus@...> wrote:

Hi all, I have been lurking and learning here for quite some time. Recently we had a Pt. that we could some expert consultations on .....

We were called by BLS at at 9am for a 25y/o female, at home c/o some slight chest discomfort x 1 hour. Her BP was 140/90, HR="fast and irregular", RR=20.

We found her sitting on a bed, Alert and oriented, and pale. She states that she was doing her normal morning chores around the house when she stared feeling some discomfort. Over a few years She has had this feeling a few times, but it always went away after a few minutes. Her doctors never found anything noteworthy. This time it is already an hour and it has not stopped. She denies any history, or Allergies, and is on Lo/Ovral.

We placed the monitor on her and found the ekg's tracings that are attached, runs of wide complex tachycardia increasing from a few beats at a time to runs that last over a minute. Pt presentation & vitals stable throughout.

Dov Pincus

EMT-P (NY)

#10680

From: Neal Weers <nweers@...>
Date: Fri Oct 31, 2008 7:49 pm
Subject: Re: 25 y/o Chest Discomfort

nweers

Offline

I conferred with the electrophysiologist I'm working with today, and his first response is "Where's this patient at?" I'm sure he was looking at ablating it as soon as possible. His point was the same as Dr. Matera, as there are some "normal" QRS's in the strip with a tight coupling which allowed conduction down the AV node and blocked the pathway, where as a conducted beat with rate dependent BBB would still have a bundle branch block with such a tight coupling interval.

PS, I would go transeptal and head over to the left lateral wall area for this one.

Neal

--- On Fri, 10/31/08, PMATERAMD@... <PMATERAMD@...> wrote:

From: PMATERAMD@... <PMATERAMD@...>
Subject: Re: [ekg_club] 25 y/o Chest Discomfort
To: ekg_club@yahoogroups.com
Date: Friday, October 31, 2008, 1:54 PM

very nice strips, af/aF with accessory path is possible, wpw type b, as this does not seem to be a rate related RBBB induced by a svt, anyway if you look at beats 1 and 14 on ecg 2 there seems to be what is probably the patients baseline complex and their morphology doesn't seem to be rate dependant so this is likely an svt induced, af/aF/svt, tachy with accessory path conduction, the vitals do not seem appropriate for this s+s+ecg, could be exog//endog B-stim produced, ie, coke, caffeine, ice // thyroid, renin, vma/epi/norepi- pheo, apparently stable at present, prep for tx, leave her alone and get to ED for further eval, let us know what happened

Paul

Paul Matera, MD, FAEP, FAAIM, EMTP
Clinical Medicine, Emergency Services, Clinical Electrocardiography , Medical Education
Director Emeritus - Critical Care Units/Emergency Medicine, Providence Hospital, DC
Medical Director/Reserve Officer - Maryland State Police, MNRP/STAR Team
Clinical Associate Professor - Medicine and Health Care Science, GWU, DC

In a message dated 10/31/2008 1:24:01 P.M. Eastern Daylight Time, dov_pincus@ibi. com writes:

Hi all, I have been lurking and learning here for quite some time. Recently we had a Pt. that we could some expert consultations on .....

We were called by BLS at at 9am for a 25y/o female, at home c/o some slight chest discomfort x 1 hour. Her BP was 140/90, HR="fast and irregular", RR=20.

We found her sitting on a bed, Alert and oriented, and pale. She states that she was doing her normal morning chores around the house when she stared feeling some discomfort. Over a few years She has had this feeling a few times, but it always went away after a few minutes. Her doctors never found anything noteworthy. This time it is already an hour and it has not stopped. She denies any history, or Allergies, and is on Lo/Ovral.

We placed the monitor on her and found the ekg's tracings that are attached, runs of wide complex tachycardia increasing from a few beats at a time to runs that last over a minute. Pt presentation & vitals stable throughout.

Dov Pincus

EMT-P (NY)

Plan your next getaway with AOL Travel. Check out Today's Hot 5 Travel Deals!

#10679

From: Neal Weers <nweers@...>
Date: Fri Oct 31, 2008 7:15 pm
Subject: Re: 25 y/o Chest Discomfort

nweers

Offline

OK, same thought, but I should still bow down with that much analysis!

--- On Fri, 10/31/08, PMATERAMD@... <PMATERAMD@...> wrote:

From: PMATERAMD@... <PMATERAMD@...>
Subject: Re: [ekg_club] 25 y/o Chest Discomfort
To: ekg_club@yahoogroups.com
Date: Friday, October 31, 2008, 1:54 PM

very nice strips, af/aF with accessory path is possible, wpw type b, as this does not seem to be a rate related RBBB induced by a svt, anyway if you look at beats 1 and 14 on ecg 2 there seems to be what is probably the patients baseline complex and their morphology doesn't seem to be rate dependant so this is likely an svt induced, af/aF/svt, tachy with accessory path conduction, the vitals do not seem appropriate for this s+s+ecg, could be exog//endog B-stim produced, ie, coke, caffeine, ice // thyroid, renin, vma/epi/norepi- pheo, apparently stable at present, prep for tx, leave her alone and get to ED for further eval, let us know what happened

Paul

Paul Matera, MD, FAEP, FAAIM, EMTP
Clinical Medicine, Emergency Services, Clinical Electrocardiography , Medical Education
Director Emeritus - Critical Care Units/Emergency Medicine, Providence Hospital, DC
Medical Director/Reserve Officer - Maryland State Police, MNRP/STAR Team
Clinical Associate Professor - Medicine and Health Care Science, GWU, DC

In a message dated 10/31/2008 1:24:01 P.M. Eastern Daylight Time, dov_pincus@ibi. com writes:

Hi all, I have been lurking and learning here for quite some time. Recently we had a Pt. that we could some expert consultations on .....

We were called by BLS at at 9am for a 25y/o female, at home c/o some slight chest discomfort x 1 hour. Her BP was 140/90, HR="fast and irregular", RR=20.

We found her sitting on a bed, Alert and oriented, and pale. She states that she was doing her normal morning chores around the house when she stared feeling some discomfort. Over a few years She has had this feeling a few times, but it always went away after a few minutes. Her doctors never found anything noteworthy. This time it is already an hour and it has not stopped. She denies any history, or Allergies, and is on Lo/Ovral.

We placed the monitor on her and found the ekg's tracings that are attached, runs of wide complex tachycardia increasing from a few beats at a time to runs that last over a minute. Pt presentation & vitals stable throughout.

Dov Pincus

EMT-P (NY)

Plan your next getaway with AOL Travel. Check out Today's Hot 5 Travel Deals!

#10678

From: PMATERAMD@...
Date: Fri Oct 31, 2008 2:54 pm
Subject: Re: 25 y/o Chest Discomfort

pmateramd

Offline

very nice strips, af/aF with accessory path is possible, wpw type b, as this does not seem to be a rate related RBBB induced by a svt, anyway if you look at beats 1 and 14 on ecg 2 there seems to be what is probably the patients baseline complex and their morphology doesn't seem to be rate dependant so this is likely an svt induced, af/aF/svt, tachy with accessory path conduction, the vitals do not seem appropriate for this s+s+ecg, could be exog//endog B-stim produced, ie, coke, caffeine, ice // thyroid, renin, vma/epi/norepi-pheo, apparently stable at present, prep for tx, leave her alone and get to ED for further eval, let us know what happened

Paul

Paul Matera, MD, FAEP, FAAIM, EMTP
Clinical Medicine, Emergency Services, Clinical Electrocardiography, Medical Education
Director Emeritus - Critical Care Units/Emergency Medicine, Providence Hospital, DC
Medical Director/Reserve Officer - Maryland State Police, MNRP/STAR Team
Clinical Associate Professor - Medicine and Health Care Science, GWU, DC

In a message dated 10/31/2008 1:24:01 P.M. Eastern Daylight Time, dov_pincus@... writes:

Hi all, I have been lurking and learning here for quite some time. Recently we had a Pt. that we could some expert consultations on .....

We were called by BLS at at 9am for a 25y/o female, at home c/o some slight chest discomfort x 1 hour. Her BP was 140/90, HR="fast and irregular", RR=20.

We found her sitting on a bed, Alert and oriented, and pale. She states that she was doing her normal morning chores around the house when she stared feeling some discomfort. Over a few years She has had this feeling a few times, but it always went away after a few minutes. Her doctors never found anything noteworthy. This time it is already an hour and it has not stopped. She denies any history, or Allergies, and is on Lo/Ovral.

We placed the monitor on her and found the ekg's tracings that are attached, runs of wide complex tachycardia increasing from a few beats at a time to runs that last over a minute. Pt presentation & vitals stable throughout.

Dov Pincus

EMT-P (NY)

Plan your next getaway with AOL Travel. Check out Today's Hot 5 Travel Deals!

#10677

From: Neal Weers <nweers@...>
Date: Fri Oct 31, 2008 6:52 pm
Subject: Re: 25 y/o Chest Discomfort

nweers

Offline

Looks like a nice A Fib with WPW. It would be nice to get a sinus recording and look for preexcitation (12-lead obviously). But if you look at the 12-lead, there appears to be a delta wave in V6 on the QRS complexes. Usually a WPW ablation will allow a lot less tachycardia and the atrial fibrillation subsides in these WPW cases.

Neal

--- On Fri, 10/31/08, Nikiah Nudell <medicnick@...> wrote:

From: Nikiah Nudell <medicnick@...>
Subject: Re: [ekg_club] 25 y/o Chest Discomfort
To: ekg_club@yahoogroups.com
Date: Friday, October 31, 2008, 12:52 PM

Hi Dov,

Hey its been a while since we had a good (orthdromic, antidromic, VFlutter) case.

I am surprised that she had good vitals... are you sure about that?

I'd be concerned about a congenital abnormality, such as WPW.

Cheers,

Nick

On Fri, Oct 31, 2008 at 13:22, <dov_pincus@ibi. com> wrote:

Hi all, I have been lurking and learning here for quite some time. Recently we had a Pt. that we could some expert consultations on .....

We were called by BLS at at 9am for a 25y/o female, at home c/o some slight chest discomfort x 1 hour. Her BP was 140/90, HR="fast and irregular", RR=20.

We found her sitting on a bed, Alert and oriented, and pale. She states that she was doing her normal morning chores around the house when she stared feeling some discomfort. Over a few years She has had this feeling a few times, but it always went away after a few minutes. Her doctors never found anything noteworthy. This time it is already an hour and it has not stopped. She denies any history, or Allergies, and is on Lo/Ovral.

We placed the monitor on her and found the ekg's tracings that are attached, runs of wide complex tachycardia increasing from a few beats at a time to runs that last over a minute. Pt presentation & vitals stable throughout.

Dov Pincus

EMT-P (NY)

.

#10676

From: "Nikiah Nudell" <medicnick@...>
Date: Fri Oct 31, 2008 5:52 pm
Subject: Re: 25 y/o Chest Discomfort

mtparamednick

Offline

Hi Dov,

Hey its been a while since we had a good (orthdromic, antidromic, VFlutter) case.

I am surprised that she had good vitals... are you sure about that?

I'd be concerned about a congenital abnormality, such as WPW.

Cheers,

Nick

On Fri, Oct 31, 2008 at 13:22, <dov_pincus@...> wrote:

Hi all, I have been lurking and learning here for quite some time. Recently we had a Pt. that we could some expert consultations on .....

We were called by BLS at at 9am for a 25y/o female, at home c/o some slight chest discomfort x 1 hour. Her BP was 140/90, HR="fast and irregular", RR=20.

We found her sitting on a bed, Alert and oriented, and pale. She states that she was doing her normal morning chores around the house when she stared feeling some discomfort. Over a few years She has had this feeling a few times, but it always went away after a few minutes. Her doctors never found anything noteworthy. This time it is already an hour and it has not stopped. She denies any history, or Allergies, and is on Lo/Ovral.

We placed the monitor on her and found the ekg's tracings that are attached, runs of wide complex tachycardia increasing from a few beats at a time to runs that last over a minute. Pt presentation & vitals stable throughout.

Dov Pincus

EMT-P (NY)

.

#10675

From: <dov_pincus@...>
Date: Fri Oct 31, 2008 5:22 pm
Subject: 25 y/o Chest Discomfort

qwe4442003

Offline

Hi all, I have been lurking and learning here for quite some time. Recently we had a Pt. that we could some expert consultations on .....

We were called by BLS at at 9am for a 25y/o female, at home c/o some slight chest discomfort x 1 hour. Her BP was 140/90, HR="fast and irregular", RR=20.

We found her sitting on a bed, Alert and oriented, and pale. She states that she was doing her normal morning chores around the house when she stared feeling some discomfort. Over a few years She has had this feeling a few times, but it always went away after a few minutes. Her doctors never found anything noteworthy. This time it is already an hour and it has not stopped. She denies any history, or Allergies, and is on Lo/Ovral.

We placed the monitor on her and found the ekg's tracings that are attached, runs of wide complex tachycardia increasing from a few beats at a time to runs that last over a minute. Pt presentation & vitals stable throughout.

Dov Pincus

EMT-P (NY)

#10674

From: "Nikiah Nudell" <medicnick@...>
Date: Fri Oct 31, 2008 2:08 am
Subject: Re: Matt added you as a friend on Reunion.com!

mtparamednick

Offline

Matt it looks like they got you too. I hope your address book is small.
Nick


On 10/30/08, Matt Stefanich <bf6805@...> wrote:
> Hi,
>
> 	 I looked for you on Reunion.com, but you weren't there. Please connect
> with me so we can keep in touch.
> 	 -Matt
>
> 	 Do You Know Matt?
> 	 YES - Connect with Matt, and see who's searching for you
> 	
http://smtp26.mail.reunion.com:80/track?type=click&mailingid=13500&messageid=360\
0&databaseid=1223409114&serial=1207176510&emailid=ekg_club@yahoogroups.com&useri\
d=475753&extra=&&&2002&&&http://www.reunion.com/showInviteRegistration.do?uid=29\
6106547
> 	 NO - I don't know Matt
>
http://smtp26.mail.reunion.com:80/track?type=click&mailingid=13500&messageid=360\
0&databaseid=1223409114&serial=1207176510&emailid=ekg_club@yahoogroups.com&useri\
d=475753&extra=&&&2000&&&http://www.reunion.com/showInviteRegistration.do?unsub=\
true&invitee=ekg_club@yahoogroups.com&uid=296106547
> 	 ----------------------------
>
> 	 Reunion.com - Find Everyone from Your Past.
> 	 You have received this e-mail because a Reunion.com Member sent an
> invitation to
> 	 this e-mail address. For assistance, please refer to our FAQ or Contact
> Us.
>
http://smtp26.mail.reunion.com:80/track?type=click&mailingid=13500&messageid=360\
0&databaseid=1223409114&serial=1207176510&emailid=ekg_club@yahoogroups.com&useri\
d=475753&extra=&&&2001&&&http://help.reunion.com/selfhelp?lid=2
> 	 Our Address: 2118 Wilshire Blvd., Box 1008, Santa Monica, CA 90403-5784
>

--
Sent from my mobile device

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#10673

From: Matt Stefanich <bf6805@...>
Date: Fri Oct 31, 2008 2:03 am
Subject: Matt added you as a friend on Reunion.com!

bf6805

Offline

Matt Stefanich added you as a friend on Reunion.com.
Please confirm you know Matt so we can connect you.

Do you know Matt?

Yes

Accept this connection and you'll see Matt's profile and photos for free!
You'll also get access to the popular feature: Who's Searching for YOU?

Reunion.com - Find Everyone from Your Past.™
You have received this email because a Member
sent an invitation to this email address.
For assistance, please refer to our FAQ or Contact Us .
Our Address: 2118 Wilshire Blvd., Box 1008, Santa Monica, CA 90403-5784

Reply | Forward | Messages in this Topic (2)

#10672

From: "Tom Bouthillet" <tbouthillet@...>
Date: Thu Oct 30, 2008 7:19 pm
Subject: Re: Re: One from the vault

code3insc

Offline

Do you think the baseline rhythm is atrial fibrillation with bifascicular block RBBB/LAFB?

Tom

On Thu, Oct 30, 2008 at 8:55 AM, Stephen Smith <smith253@...> wrote:

More important is what the cause is: there is lots of ST elevation (yes, you can see this in spite of the wide QRS) in I and reciprocal depression in II and III. Lateral acute MI.

On 10/29/08, craig kalapus <aruredytoo@...> wrote:

Dear Tom:

Yes it certainly does! perhaps mine was an attempt to glean alot out of a little...in our realm, limited exams=limited information=limited ability to accurately diagnose. best to stick to that tenet...huh! should have thought you'd drop a bomb on us! Good Case!

Ck

--- On Wed, 10/29/08, Tom Bouthillet <tbouthillet@...> wrote:

From: Tom Bouthillet <tbouthillet@...>
Subject: Re: [ekg_club] Re: One from the vault
To: ekg_club@yahoogroups.com
Date: Wednesday, October 29, 2008, 6:43 AM

Thank you very much! Always nice to see a new contributor. I found your interpretation interesting. Does this 12 lead ECG change your perception?

Tom

On Tue, Oct 28, 2008 at 7:37 PM, aruredytoo <aruredytoo@yahoo. com> wrote:

--- In ekg_club@yahoogroup s.com, "Tom Bouthillet" <tbouthillet@ ...> wrote:
>
> I don't have any patient information, so don't ask!
>
> What do you think of this heart rhythm?
>
> Tom
>

Dear Tom:

My best Guess..... sinus with LBBB intrinsic rhythm...then PAT....Then
Sinus LBBB beat / PVC with compensatory pause...then LBBB sinus beat
followed by another uni-focal PVC!? BTW....Excellent Group!

S. Craig Kalapus, RDCS
Cardio-Vascular Ultrasound Technologist
San Francisco

--
Stephen W. Smith, MD
Faculty Emergency Physician
Hennepin County Medical Center
Associate Professor of Emergency Medicine
University of Minnesota School of Medicine

#10671

From: "Stephen Smith" <smith253@...>
Date: Thu Oct 30, 2008 12:55 pm
Subject: Re: Re: One from the vault

rpmpaddler

Offline

More important is what the cause is: there is lots of ST elevation (yes, you can see this in spite of the wide QRS) in I and reciprocal depression in II and III. Lateral acute MI.

On 10/29/08, craig kalapus <aruredytoo@...> wrote:

Dear Tom:

Yes it certainly does! perhaps mine was an attempt to glean alot out of a little...in our realm, limited exams=limited information=limited ability to accurately diagnose. best to stick to that tenet...huh! should have thought you'd drop a bomb on us! Good Case!

Ck

--- On Wed, 10/29/08, Tom Bouthillet <tbouthillet@...> wrote:

From: Tom Bouthillet <tbouthillet@...>
Subject: Re: [ekg_club] Re: One from the vault
To: ekg_club@yahoogroups.com
Date: Wednesday, October 29, 2008, 6:43 AM

Thank you very much! Always nice to see a new contributor. I found your interpretation interesting. Does this 12 lead ECG change your perception?

Tom

On Tue, Oct 28, 2008 at 7:37 PM, aruredytoo <aruredytoo@yahoo. com> wrote:

--- In ekg_club@yahoogroup s.com, "Tom Bouthillet" <tbouthillet@ ...> wrote:
>
> I don't have any patient information, so don't ask!
>
> What do you think of this heart rhythm?
>
> Tom
>

Dear Tom:

My best Guess..... sinus with LBBB intrinsic rhythm...then PAT....Then
Sinus LBBB beat / PVC with compensatory pause...then LBBB sinus beat
followed by another uni-focal PVC!? BTW....Excellent Group!

S. Craig Kalapus, RDCS
Cardio-Vascular Ultrasound Technologist
San Francisco

--
Stephen W. Smith, MD
Faculty Emergency Physician
Hennepin County Medical Center
Associate Professor of Emergency Medicine
University of Minnesota School of Medicine

#10670

From: craig kalapus <aruredytoo@...>
Date: Wed Oct 29, 2008 5:24 pm
Subject: Re: Re: One from the vault

aruredytoo

Offline

Dear Tom:

Yes it certainly does! perhaps mine was an attempt to glean alot out of a little...in our realm, limited exams=limited information=limited ability to accurately diagnose. best to stick to that tenet...huh! should have thought you'd drop a bomb on us! Good Case!

Ck

--- On Wed, 10/29/08, Tom Bouthillet <tbouthillet@...> wrote:

From: Tom Bouthillet <tbouthillet@...>
Subject: Re: [ekg_club] Re: One from the vault
To: ekg_club@yahoogroups.com
Date: Wednesday, October 29, 2008, 6:43 AM

Thank you very much! Always nice to see a new contributor. I found your interpretation interesting. Does this 12 lead ECG change your perception?

Tom

On Tue, Oct 28, 2008 at 7:37 PM, aruredytoo <aruredytoo@yahoo. com> wrote:

--- In ekg_club@yahoogroup s.com, "Tom Bouthillet" <tbouthillet@ ...> wrote:
>
> I don't have any patient information, so don't ask!
>
> What do you think of this heart rhythm?
>
> Tom
>

Dear Tom:

My best Guess..... sinus with LBBB intrinsic rhythm...then PAT....Then
Sinus LBBB beat / PVC with compensatory pause...then LBBB sinus beat
followed by another uni-focal PVC!? BTW....Excellent Group!

S. Craig Kalapus, RDCS
Cardio-Vascular Ultrasound Technologist
San Francisco

#10669

From: "Tom Bouthillet" <tbouthillet@...>
Date: Wed Oct 29, 2008 1:43 pm
Subject: Re: Re: One from the vault

code3insc

Offline

Thank you very much! Always nice to see a new contributor. I found your interpretation interesting. Does this 12 lead ECG change your perception?

Tom

On Tue, Oct 28, 2008 at 7:37 PM, aruredytoo <aruredytoo@...> wrote:

--- In ekg_club@yahoogroups.com, "Tom Bouthillet" <tbouthillet@...> wrote:
>
> I don't have any patient information, so don't ask!
>
> What do you think of this heart rhythm?
>
> Tom
>

Dear Tom:

My best Guess..... sinus with LBBB intrinsic rhythm...then PAT....Then
Sinus LBBB beat / PVC with compensatory pause...then LBBB sinus beat
followed by another uni-focal PVC!? BTW....Excellent Group!

S. Craig Kalapus, RDCS
Cardio-Vascular Ultrasound Technologist
San Francisco

#10668

From: "Tom Bouthillet" <tbouthillet@...>
Date: Wed Oct 29, 2008 1:37 pm
Subject: Re: Re: pvcs with p waves?

code3insc

Offline

This is similar to Paul Materra MD's explanation. The text calls it an "end diastolic" PVC. Remember that atrial systole is an end diastolic event. In other words, the P wave shows up exactly on time, and by coincidence the PVC falls after the P wave (but before the regularly scheduled QRS complex). If it occurs late enough, it overlaps with the regularly scheduled QRS complex and creates a so-called "fusion" complex. In other words, the P wave does not "belong" to the PVC.

Tom

On Wed, Oct 29, 2008 at 3:25 AM, jnoube <jnoube@...> wrote:

--- In ekg_club@yahoogroups.com, "pookawiz" <pookawiz@...> wrote:
>
> I was wondering if it was possible for pvcs to have p waves. Our team
> leader in the Telemetry room swears they can. I've never seen this
> before. I thought it looked more like junctional to me. Rate was 50
> ish and the pr interval was .10 or less.
>
> Thanks for your help.
>
It is rare but possible. See link below.

http://books.google.com/books?
id=_vWmbeuYRN8C&pg=PA403&lpg=PA403&dq=PVC+with+P+wave&source=web&ots=bF0
oHV8Kbd&sig=OeOFR29floHbsa81nOyKoRZ2rbs&hl=en&sa=X&oi=book_result&resnum
=4&ct=result#PPA403,M1

#10667

From: "jnoube" <jnoube@...>
Date: Wed Oct 29, 2008 8:25 am
Subject: Re: pvcs with p waves?

jnoube

Offline

--- In ekg_club@yahoogroups.com, "pookawiz" <pookawiz@...> wrote:
>
> I was wondering if it was possible for pvcs to have p waves. Our team
> leader in the Telemetry room swears they can. I've never seen this
> before. I thought it looked more like junctional to me. Rate was 50
> ish and the pr interval was .10 or less.
>
> Thanks for your help.
>
It is rare but possible.  See link below.

http://books.google.com/books?
id=_vWmbeuYRN8C&pg=PA403&lpg=PA403&dq=PVC+with+P+wave&source=web&ots=bF0
oHV8Kbd&sig=OeOFR29floHbsa81nOyKoRZ2rbs&hl=en&sa=X&oi=book_result&resnum
=4&ct=result#PPA403,M1

#10666

From: "aruredytoo" <aruredytoo@...>
Date: Wed Oct 29, 2008 12:37 am
Subject: Re: One from the vault

aruredytoo

Offline

--- In ekg_club@yahoogroups.com, "Tom Bouthillet" <tbouthillet@...> wrote:
>
> I don't have any patient information, so don't ask!
>
> What do you think of this heart rhythm?
>
> Tom
>

Dear Tom:

My best Guess..... sinus with LBBB intrinsic rhythm...then PAT....Then
Sinus LBBB beat / PVC with compensatory pause...then LBBB sinus beat
followed by another uni-focal PVC!?   BTW....Excellent Group!

S. Craig Kalapus, RDCS
Cardio-Vascular Ultrasound Technologist
San Francisco

#10665

From: "Tom Bouthillet" <tbouthillet@...>
Date: Tue Oct 28, 2008 9:48 pm
Subject: One from the vault

code3insc

Offline

I don't have any patient information, so don't ask!

What do you think of this heart rhythm?

Tom

#10663

From: Neal Weers <nweers@...>
Date: Tue Oct 21, 2008 1:33 pm
Subject: Re: Nudell's sign

nweers

Offline

Great example. Thanks

Neal

--- On Mon, 10/20/08, Gustavo Flores <gflores911@...> wrote:

From: Gustavo Flores <gflores911@...>
Subject: Re: [ekg_club] Nudell's sign
To: ekg_club@yahoogroups.com
Date: Monday, October 20, 2008, 12:01 AM

Hi Neal,

I've read this from other authors as well. As a matter of fact, here's a recent contribution to the list (see attached JPEG). I've been swamped to the point of not being even able to read any post. At least I am keeping them. Most of my unread messages on my inbox are from this list. I refuse to delete them until read.

Take care!

Gustavo E. Flores, MD EMT-P
www.emergencyteam. net

gflores@emergencyte am.net
gflores911@gmail. com

787-630-6301 (Puerto Rico)

On Thu, Oct 16, 2008 at 3:10 PM, Neal Weers <nweers@yahoo. com> wrote:

I have had a case of a PE from a broken ankle, sedentary female. Besides the presenting history, they had EKG changes in the inferior leads and anteroseptal leads. Dr. Marriott has mentioned if you have these two groupings of EKG (ST) changes, you should stop and think "acute cor pulmonale". Our treatment was 4 baby ASA, oxygen and an accellerator (it's to the right next to the brake) and SOB resolved upon arrival to ER. Thoughts? Anyone else read this from Marriott? I know the S1 S3 phenomenon is out there as well.....

Neal

--- On Thu, 10/16/08, Nikiah Nudell <medicnick@gmail. com> wrote:

From: Nikiah Nudell <medicnick@gmail. com>

Subject: Re: [ekg_club] Nudell's sign
To: ekg_club@yahoogroup s.com
Date: Thursday, October 16, 2008, 7:10 AM

It is a finding of cyanosis from the nipple line superiorly, described as resulting from pulmonary embolism.

If anyone would like to contribute to a write-up of this condition, lets talk. ;-)

Thanks,

Nick

On Wed, Oct 15, 2008 at 20:54, Erskine James <erskine3@cox. net> wrote:

What is Nudell's sign?

From: ekg_club@yahoogroup s.com [mailto:ekg_club@yahoogroup s.com] On Behalf Of Nikiah Nudell

Sent: Wednesday, October 15, 2008 6:01 PM
To: ekg_club@yahoogroup s.com

Subject: Re: [ekg_club] Nudell's sign

Hi Andrew,

Is this a test? ;-)

Some reports indicate 10-25% of in-hospital deaths are due to PE and 90% originate as DVT in the legs. Nudell's Sign is found primarily post mortem following severe pulomary embolism. There is a good pathophys article on the general topic at http://www.outcomes -umassmed. org/dvt/best_ practice/ .

I've seen a couple cases where the patients made it to a pulmonary perfusion scan but did not make it out of the ED. The lite explanation is the development of one or two large saddle emboli. This restricts the return flow of blood. The torso from the nipple line to the top of the head will turn purple. I don't know if that is from pressure, thrombosis, or capillary wall insufficiency.

I have to say that I've witnessed similar findings in a deteriorating pericardial tamponade although that patient did not arrest.

Do you have a good case? Pictures? More info?

Thanks

Nick

On Wed, Oct 15, 2008 at 17:25, Andrew J Bowman <andrewj.bowman@ gmail.com> wrote:

Nick,

Can you once again explain the pathophysiology behind Nudell's sign?

Thanks,

Andrew

#10662

From: Teresa M <mumsyrnbsn@...>
Date: Mon Oct 20, 2008 11:32 pm
Subject: Re: Poll results for ekg_club

mumsyrnbsn

Offline

Northeast what? Wisconsin????? GO PACK GO....:-) I know it's closed, just had to respond....lol

Terri

--- On Sun, 10/19/08, ekg_club@yahoogroups.com <ekg_club@yahoogroups.com> wrote:

From: ekg_club@yahoogroups.com <ekg_club@yahoogroups.com>
Subject: [ekg_club] Poll results for ekg_club
To: ekg_club@yahoogroups.com
Date: Sunday, October 19, 2008, 9:14 AM

The following ekg_club poll is now closed. Here are the
final results:

POLL QUESTION: In an effort to measure interest and support for hosting a Northeast EKG_Club meetup, please indicate your interest and preferences. If you can help organize this effort, know someone who could sponsor even part of the meetup, or have a great presentation, please contact Nick.
Thanks!

CHOICES AND RESULTS
- I'd definitely attend, 3 votes, 7.14%
- I might attend, 4 votes, 9.52%
- Are you kidding me? Heck no!, 2 votes, 4.76%
- August is best, 1 votes, 2.38%
- September is best, 3 votes, 7.14%
- October is best, 3 votes, 7.14%
- Philladelphia works, 2 votes, 4.76%
- Jersey Shore works, 3 votes, 7.14%
- NYC works, 2 votes, 4.76%
- Any of the locations are ok, lower cost is best, 5 votes, 11.90%
- I'd bring one person, 2 votes, 4.76%
- I'd bring two to four others, 1 votes, 2.38%
- I'd bring five or more others, 0 votes, 0.00%
- We are willing to provide education sessions, 1 votes, 2.38%
- We would want to attend education sessions, 5 votes, 11.90%
- Some of us would teach and some would attend, 2 votes, 4.76%
- We just want to party with our fellow EKG Nerds!, 3 votes, 7.14%

For more information about this group, please visit
http://groups. yahoo.com/ group/ekg_ club

For help with Yahoo! Groups, please visit
http://help. yahoo.com/ l/us/yahoo/ groups/original/ members/web/ index.html

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