--- In ekg_club@yahoogroups.com, Klaus Skrudland <lapsklaus@...> wrote:
>
> Jesse -
> You're probably looking at the right ekg, but as you can see the AV ratio
> varies from cycle to cycle. The conduction is not 2:1. There also seems to
> be AV dissociation, which is also not the case. There is some kind of 2AVB
> here, you are correct about that. My problem is that I cannot figure out
> which P waves are conducted and which are not, and what the specific kind of
> block/conduction this is.
>
> Paul - I´ve attached them again to this email
>
>
>
>
> On Mon, Jul 6, 2009 at 2:29 AM, jesse12848 <jesse12848@...> wrote:
>
> >
> >
> > --- In ekg_club@yahoogroups.com <ekg_club%40yahoogroups.com>, "jesse12848"
> > <jesse12848@> wrote:
> > >
> > > --- In ekg_club@yahoogroups.com <ekg_club%40yahoogroups.com>, Nikiah
> > Nudell <medicnick@> wrote:
> > > >
> > > > Hi Jesse,
> > > > I just wanted to clarify something you mentioned. Pwaves may be present
> > in
> > > > PVCs or PACS. One has to be careful to determine whether the Pwave is
> > > > 'associated' with the QRS complex.
> > > >
> > > > Some rythms can be tricky to differentiate in a 12 lead. If it is
> > bigeminy
> > > > with a bundle branch block, for example, it can be nearly impossible to
> > > > determine from a single 12lead which is the ectopy and which is the
> > > > underlying rhythm.
> > > >
> > > > Cheers,
> > > > Nick
> > > >
> > > > On Sun, Jul 5, 2009 at 11:12, jesse12848 <jesse12848@> wrote:
> > > >
> > > > >
> > > > >
> > > > > --- In ekg_club@yahoogroups.com <ekg_club%40yahoogroups.com><ekg_club%
> > 40yahoogroups.com>,
> > > > > "thatsuthant" <thatsuthant@> wrote:
> > > > > >
> > > > > > Hi every one,
> > > > > > How do you differentiate atrial ectopic beats from ventricular
> > ectopic
> > > > > beats?. Any one can define me please?.
> > > > > > Ventricular ectopic beats are clearly seen on ECG . But atrial
> > ectopic
> > > > > beats, how you all find those?. Please give some of your thoughts.
> > > > > >
> > > > > > Thanks
> > > > > >
> > > > > >
> > > > > >
> > > > > > --- In ekg_club@yahoogroups.com
<ekg_club%40yahoogroups.com><ekg_club%
> > 40yahoogroups.com>, Klaus
> > > > > Skrudland <lapsklaus@> wrote:
> > > > > > >
> > > > > > > Hi all. Just want to present to you a case of what I believe is a
> > quite
> > > > > > > uncommon ectopic rhythm.
> > > > > > >
> > > > > > > The patient is a 55 y/o male with a well known paroxysmal atrial
> > > > > > > fibrillation. He uses flecainide and metoprolol and was admitted
> > for
> > > > > onset
> > > > > > > of what he thought was atrial fibrillation.
> > > > > > >
> > > > > > > As you will see from the ecg, the ventricular rate is irregular.
> > Right
> > > > > > > precordial leads show ectopic, positive P waves. PP intervals are
> > > > > regular
> > > > > > > with a rate of 230 bpm. When marching them out with a caliper
> > (see the
> > > > > dots
> > > > > > > I made), they seem to march right through the QRS complexes and
> > don´t
> > > > > seem
> > > > > > > to get conducted. However, there can´t be AV dissociation, as
> > there is
> > > > > no
> > > > > > > evidence of an escape pacemaker present (and the ventricular rate
> > is
> > > > > > > irregular).
> > > > > > >
> > > > > > > As a matter of fact, the P waves does seem to get conducted after
> > all.
> > > > > My
> > > > > > > colleague Terje (the other Norwegian here in the club) pointed
> > out that
> > > > > the
> > > > > > > PR interval in fact gets progressively longer. And at this point,
> > I´m
> > > > > > > struggling to understand the rest of the mechanism. Most likely,
> > this
> > > > > atrial
> > > > > > > tachycardia with some kind of Wenkebach conduction.
> > > > > > >
> > > > > > > Comments? Thoughts? Ideas? Anyone wanna make a ladderdiagram to
> > explain
> > > > > the
> > > > > > > mechanism?! ;-)
> > > > > > >
> > > > > > > klaus
> > > > > > >
> > > > > >
> > > > > In the caes of a true atrial ectopic beat, the QRS will be preceded
> > by a
> > > > > definite, upright P wave. P wave morphology may fulctuate (wandering
> > > > > pacemaker, etc.), but if the premature beat is truely atrial in
> > origin then
> > > > > a P wave will be present. Another way to distinguish PACs from PVCs
> > is to
> > > > > view them in leads I and III. Also remember that PACs have a QRS
> > duration
> > > > > time of < 0.12 sec, whereas PVCs almost always have duration times >
> > 0.12
> > > > > sec.
> > > > > If your sure that it's a PVC your looking at, you can determine L or
> > R
> > > > > origin by viewing it in MCL1/v1. L vent PVCs will be positive in
> > deflection
> > > > > while R vent PVCs will be aberrant. Hope this helps.
> > > > >
> > > > >
> > > > >
> > > >
> > > Nick, right on. Thats a great catch. It is important to determine wether
> > the P wave is in fact associated with the QRS. Thanks for the correction.
> > >
> > I'm just a lowly paramedic :-), and I just looked at Klaus attached file of
> > the rhythm in question. V1 appears to display a 2nd degree type II AV
> > blockade. Am I wrong in my interpretation or am I looking at the wrong
> > rhythm? Sorry if I sound a little confused.
> >
> >
> >
>
>
>
> --
> Mvh,
> Klaus Nilsen Skrudland
>
> http://www.lapsklaus.com
> http://ecgblog.com
> + 47 99 38 67 55
>
Paul- Would it be too simple to call this rhythm a 2nd degree type I AV
blockade? V1 appears to show a gradual lengthening of the P-R interval until,
after the third beat, a QRS is dropped. Also, am I seeing U waves in L3?

--- In ekg_club@yahoogroups.com, "jesse12848" <jesse12848@...> wrote:
>
> --- In ekg_club@yahoogroups.com, Nikiah Nudell <medicnick@> wrote:
> >
> > Hi Jesse,
> > I just wanted to clarify something you mentioned. Pwaves may be present in
> > PVCs or PACS. One has to be careful to determine whether the Pwave is
> > 'associated' with the QRS complex.
> >
> > Some rythms can be tricky to differentiate in a 12 lead. If it is bigeminy
> > with a bundle branch block, for example, it can be nearly impossible to
> > determine from a single 12lead which is the ectopy and which is the
> > underlying rhythm.
> >
> > Cheers,
> > Nick
> >
> > On Sun, Jul 5, 2009 at 11:12, jesse12848 <jesse12848@> wrote:
> >
> > >
> > >
> > >   --- In ekg_club@yahoogroups.com <ekg_club%40yahoogroups.com>,
> > > "thatsuthant" <thatsuthant@> wrote:
> > > >
> > > > Hi every one,
> > > > How do you differentiate atrial ectopic beats from ventricular ectopic
> > > beats?. Any one can define me please?.
> > > > Ventricular ectopic beats are clearly seen on ECG . But atrial ectopic
> > > beats, how you all find those?. Please give some of your thoughts.
> > > >
> > > > Thanks
> > > >
> > > >
> > > >
> > > > --- In ekg_club@yahoogroups.com <ekg_club%40yahoogroups.com>, Klaus
> > > Skrudland <lapsklaus@> wrote:
> > > > >
> > > > > Hi all. Just want to present to you a case of what I believe is a
quite
> > > > > uncommon ectopic rhythm.
> > > > >
> > > > > The patient is a 55 y/o male with a well known paroxysmal atrial
> > > > > fibrillation. He uses flecainide and metoprolol and was admitted for
> > > onset
> > > > > of what he thought was atrial fibrillation.
> > > > >
> > > > > As you will see from the ecg, the ventricular rate is irregular. Right
> > > > > precordial leads show ectopic, positive P waves. PP intervals are
> > > regular
> > > > > with a rate of 230 bpm. When marching them out with a caliper (see the
> > > dots
> > > > > I made), they seem to march right through the QRS complexes and don´t
> > > seem
> > > > > to get conducted. However, there can´t be AV dissociation, as there
is
> > > no
> > > > > evidence of an escape pacemaker present (and the ventricular rate is
> > > > > irregular).
> > > > >
> > > > > As a matter of fact, the P waves does seem to get conducted after all.
> > > My
> > > > > colleague Terje (the other Norwegian here in the club) pointed out
that
> > > the
> > > > > PR interval in fact gets progressively longer. And at this point, I´m
> > > > > struggling to understand the rest of the mechanism. Most likely, this
> > > atrial
> > > > > tachycardia with some kind of Wenkebach conduction.
> > > > >
> > > > > Comments? Thoughts? Ideas? Anyone wanna make a ladderdiagram to
explain
> > > the
> > > > > mechanism?! ;-)
> > > > >
> > > > > klaus
> > > > >
> > > >
> > > In the caes of a true atrial ectopic beat, the QRS will be preceded by a
> > > definite, upright P wave. P wave morphology may fulctuate (wandering
> > > pacemaker, etc.), but if the premature beat is truely atrial in origin
then
> > > a P wave will be present. Another way to distinguish PACs from PVCs is to
> > > view them in leads I and III. Also remember that PACs have a QRS duration
> > > time of < 0.12 sec, whereas PVCs almost always have duration times > 0.12
> > > sec.
> > > If your sure that it's a PVC your looking at, you can determine L or R
> > > origin by viewing it in MCL1/v1. L vent PVCs will be positive in
deflection
> > > while R vent PVCs will be aberrant. Hope this helps.
> > >
> > >
> > >
> >
> Nick, right on. Thats a great catch. It is important to determine wether the P
wave is in fact associated with the QRS. Thanks for the correction.
>
I'm just a lowly paramedic :-), and I just looked at Klaus attached file of the
rhythm in question. V1 appears to display a 2nd degree type II AV blockade. Am I
wrong in my interpretation or am I looking at the wrong rhythm? Sorry if I sound
a little confused.

--- In ekg_club@yahoogroups.com, Nikiah Nudell <medicnick@...> wrote:
>
> Hi Jesse,
> I just wanted to clarify something you mentioned. Pwaves may be present in
> PVCs or PACS. One has to be careful to determine whether the Pwave is
> 'associated' with the QRS complex.
>
> Some rythms can be tricky to differentiate in a 12 lead. If it is bigeminy
> with a bundle branch block, for example, it can be nearly impossible to
> determine from a single 12lead which is the ectopy and which is the
> underlying rhythm.
>
> Cheers,
> Nick
>
> On Sun, Jul 5, 2009 at 11:12, jesse12848 <jesse12848@...> wrote:
>
> >
> >
> >   --- In ekg_club@yahoogroups.com <ekg_club%40yahoogroups.com>,
> > "thatsuthant" <thatsuthant@> wrote:
> > >
> > > Hi every one,
> > > How do you differentiate atrial ectopic beats from ventricular ectopic
> > beats?. Any one can define me please?.
> > > Ventricular ectopic beats are clearly seen on ECG . But atrial ectopic
> > beats, how you all find those?. Please give some of your thoughts.
> > >
> > > Thanks
> > >
> > >
> > >
> > > --- In ekg_club@yahoogroups.com <ekg_club%40yahoogroups.com>, Klaus
> > Skrudland <lapsklaus@> wrote:
> > > >
> > > > Hi all. Just want to present to you a case of what I believe is a quite
> > > > uncommon ectopic rhythm.
> > > >
> > > > The patient is a 55 y/o male with a well known paroxysmal atrial
> > > > fibrillation. He uses flecainide and metoprolol and was admitted for
> > onset
> > > > of what he thought was atrial fibrillation.
> > > >
> > > > As you will see from the ecg, the ventricular rate is irregular. Right
> > > > precordial leads show ectopic, positive P waves. PP intervals are
> > regular
> > > > with a rate of 230 bpm. When marching them out with a caliper (see the
> > dots
> > > > I made), they seem to march right through the QRS complexes and don´t
> > seem
> > > > to get conducted. However, there can´t be AV dissociation, as there is
> > no
> > > > evidence of an escape pacemaker present (and the ventricular rate is
> > > > irregular).
> > > >
> > > > As a matter of fact, the P waves does seem to get conducted after all.
> > My
> > > > colleague Terje (the other Norwegian here in the club) pointed out that
> > the
> > > > PR interval in fact gets progressively longer. And at this point, I´m
> > > > struggling to understand the rest of the mechanism. Most likely, this
> > atrial
> > > > tachycardia with some kind of Wenkebach conduction.
> > > >
> > > > Comments? Thoughts? Ideas? Anyone wanna make a ladderdiagram to explain
> > the
> > > > mechanism?! ;-)
> > > >
> > > > klaus
> > > >
> > >
> > In the caes of a true atrial ectopic beat, the QRS will be preceded by a
> > definite, upright P wave. P wave morphology may fulctuate (wandering
> > pacemaker, etc.), but if the premature beat is truely atrial in origin then
> > a P wave will be present. Another way to distinguish PACs from PVCs is to
> > view them in leads I and III. Also remember that PACs have a QRS duration
> > time of < 0.12 sec, whereas PVCs almost always have duration times > 0.12
> > sec.
> > If your sure that it's a PVC your looking at, you can determine L or R
> > origin by viewing it in MCL1/v1. L vent PVCs will be positive in deflection
> > while R vent PVCs will be aberrant. Hope this helps.
> >
> >
> >
>
Nick, right on. Thats a great catch. It is important to determine wether the P
wave is in fact associated with the QRS. Thanks for the correction.

Sent from my Verizon Wireless BlackBerry

--- In ekg_club@yahoogroups.com, "thatsuthant" <thatsuthant@...> wrote:
>
> Hi every one,
> How do you differentiate atrial ectopic beats from ventricular ectopic beats?.
Any one can define me please?.
> Ventricular ectopic beats are clearly seen on ECG . But atrial ectopic beats,
how you all find those?. Please give some of your thoughts.
>
> Thanks
>
>
>
> --- In ekg_club@yahoogroups.com, Klaus Skrudland <lapsklaus@> wrote:
> >
> > Hi all. Just want to present to you a case of what I believe is a quite
> > uncommon ectopic rhythm.
> >
> > The patient is a 55 y/o male with a well known paroxysmal atrial
> > fibrillation. He uses flecainide and metoprolol and was admitted for onset
> > of what he thought was atrial fibrillation.
> >
> > As you will see from the ecg, the ventricular rate is irregular. Right
> > precordial leads show ectopic, positive P waves. PP intervals are regular
> > with a rate of 230 bpm. When marching them out with a caliper (see the dots
> > I made), they seem to march right through the QRS complexes and don´t seem
> > to get conducted. However, there can´t be AV dissociation, as there is no
> > evidence of an escape pacemaker present (and the ventricular rate is
> > irregular).
> >
> > As a matter of fact, the P waves does seem to get conducted after all. My
> > colleague Terje (the other Norwegian here in the club) pointed out that the
> > PR interval in fact gets progressively longer. And at this point, I´m
> > struggling to understand the rest of the mechanism. Most likely, this atrial
> > tachycardia with some kind of Wenkebach conduction.
> >
> > Comments? Thoughts? Ideas? Anyone wanna make a ladderdiagram to explain the
> > mechanism?! ;-)
> >
> > klaus
> >
>
In the caes of a true atrial ectopic beat, the QRS will be preceded by a
definite, upright P wave. P wave morphology may fulctuate (wandering pacemaker,
etc.), but if the premature beat is truely atrial in origin then a P wave will
be present. Another way to distinguish PACs from PVCs is to view them in leads I
and III. Also remember that PACs have a QRS duration time of < 0.12 sec, whereas
PVCs almost always have duration times > 0.12 sec.
If your sure that it's a PVC your looking at, you can determine L or R origin by
viewing it in MCL1/v1. L vent PVCs will be positive in deflection while R vent
PVCs will be aberrant. Hope this helps.

--- In ekg_club@yahoogroups.com, "thatsuthant" <thatsuthant@...> wrote:
>
> Hi every one,
> How do you differentiate atrial ectopic beats from ventricular ectopic beats?.
Any one can define me please?.
> Ventricular ectopic beats are clearly seen on ECG . But atrial ectopic beats,
how you all find those?. Please give some of your thoughts.
>
> Thanks
>
>
>
> --- In ekg_club@yahoogroups.com, Klaus Skrudland <lapsklaus@> wrote:
> >
> > Hi all. Just want to present to you a case of what I believe is a quite
> > uncommon ectopic rhythm.
> >
> > The patient is a 55 y/o male with a well known paroxysmal atrial
> > fibrillation. He uses flecainide and metoprolol and was admitted for onset
> > of what he thought was atrial fibrillation.
> >
> > As you will see from the ecg, the ventricular rate is irregular. Right
> > precordial leads show ectopic, positive P waves. PP intervals are regular
> > with a rate of 230 bpm. When marching them out with a caliper (see the dots
> > I made), they seem to march right through the QRS complexes and don´t seem
> > to get conducted. However, there can´t be AV dissociation, as there is no
> > evidence of an escape pacemaker present (and the ventricular rate is
> > irregular).
> >
> > As a matter of fact, the P waves does seem to get conducted after all. My
> > colleague Terje (the other Norwegian here in the club) pointed out that the
> > PR interval in fact gets progressively longer. And at this point, I´m
> > struggling to understand the rest of the mechanism. Most likely, this atrial
> > tachycardia with some kind of Wenkebach conduction.
> >
> > Comments? Thoughts? Ideas? Anyone wanna make a ladderdiagram to explain the
> > mechanism?! ;-)
> >
> > klaus
> >
>
aa

Hi every one,
How do you differentiate atrial ectopic beats from ventricular ectopic beats?.
Any one can define me please?.
Ventricular ectopic beats are clearly seen on ECG . But atrial ectopic beats,
how you all find those?. Please give some of your thoughts.

Thanks



--- In ekg_club@yahoogroups.com, Klaus Skrudland <lapsklaus@...> wrote:
>
> Hi all. Just want to present to you a case of what I believe is a quite
> uncommon ectopic rhythm.
>
> The patient is a 55 y/o male with a well known paroxysmal atrial
> fibrillation. He uses flecainide and metoprolol and was admitted for onset
> of what he thought was atrial fibrillation.
>
> As you will see from the ecg, the ventricular rate is irregular. Right
> precordial leads show ectopic, positive P waves. PP intervals are regular
> with a rate of 230 bpm. When marching them out with a caliper (see the dots
> I made), they seem to march right through the QRS complexes and don´t seem
> to get conducted. However, there can´t be AV dissociation, as there is no
> evidence of an escape pacemaker present (and the ventricular rate is
> irregular).
>
> As a matter of fact, the P waves does seem to get conducted after all. My
> colleague Terje (the other Norwegian here in the club) pointed out that the
> PR interval in fact gets progressively longer. And at this point, I´m
> struggling to understand the rest of the mechanism. Most likely, this atrial
> tachycardia with some kind of Wenkebach conduction.
>
> Comments? Thoughts? Ideas? Anyone wanna make a ladderdiagram to explain the
> mechanism?! ;-)
>
> klaus
>

I guess you didn't lose!
Nick


On 07/04/2009, PMATERAMD@... <PMATERAMD@...> wrote:
> On my way home from a 3 gun (pistol rifle shotgun) combat competition, it is
> the 4th of July after all, on my blackberry now, I will take a look on my
> laptop asap
> Paul
> PMMD
> Sent from my Verizon Wireless BlackBerry
>
> -----Original Message-----
> From: Klaus Skrudland <lapsklaus@...>
>
> Date: Sat, 4 Jul 2009 21:21:33
> To: <ekg_club@yahoogroups.com>
> Subject: [ekg_club] Re: Rare ectopic rhythm
>
>
> Really, no comments?? Hmm.
>
>
>
>
>
>
> On Wed, Jul 1, 2009 at 12:56 PM, Klaus Skrudland
> <lapsklaus@...>wrote:
>
>> Hi all. Just want to present to you a case of what I believe is a quite
>> uncommon ectopic rhythm.
>>
>> The patient is a 55 y/o male with a well known paroxysmal atrial
>> fibrillation. He uses flecainide and metoprolol and was admitted for
>> onset
>> of what he thought was atrial fibrillation.
>>
>> As you will see from the ecg, the ventricular rate is irregular. Right
>> precordial leads show ectopic, positive P waves. PP intervals are regular
>> with a rate of 230 bpm. When marching them out with a caliper (see the
>> dots
>> I made), they seem to march right through the QRS complexes and don´t
>> seem
>> to get conducted. However, there can´t be AV dissociation, as there is no
>> evidence of an escape pacemaker present (and the ventricular rate is
>> irregular).
>>
>> As a matter of fact, the P waves does seem to get conducted after all. My
>> colleague Terje (the other Norwegian here in the club) pointed out that
>> the
>> PR interval in fact gets progressively longer. And at this point, I´m
>> struggling to understand the rest of the mechanism. Most likely, this
>> atrial
>> tachycardia with some kind of Wenkebach conduction.
>>
>> Comments? Thoughts? Ideas? Anyone wanna make a ladderdiagram to explain
>> the
>> mechanism?! ;-)
>>
>> klaus
>>
>
>
>
> --
> Mvh,
> Klaus Nilsen Skrudland
>
> http://www.lapsklaus.com
> http://ecgblog.com
> + 47 99 38 67 55
>
>

--
Sent from my mobile device

Sent from my Verizon Wireless BlackBerry

That sounds plausible... What would capnography look like in that
situation? The high BP concerns me still...
Nick


On 06/30/2009, wegandy1938@... <wegandy1938@...> wrote:
> There's no S1Q3T3 pattern or anything else to suggest pulmonary embolism
> that I can see.   He's tacky, so there's something happening but I agree
> with
> Paul that it's probably not cardiac.   I have seen the strip, and it's sinus
> with a LBBB and occasional PACs and one PVC.   QRS axis is 60 odd.   There
> is one interesting thing.   In leads I, II, III, and aVF the T waves are
> sometimes properly discordant but at other times not.   And it's not the
> PACs
> that are different.   There are occasional sinus beats with a concordant T
> wave.   the Qrs looks the same.   Now I don't have a clue what this means.
> I
> also don't see how it reflects anything that's causing the dyspnea.
>
> Could this guy have just produced a bunch of mucus and not been coughing
> because of the soreness from the hernia and there was a mucus plug or
> something?   The fact that he got better suggests that something "moved" or
> crawled
> back into its cave.   But the greatly diminished left side lung sounds
> trouble me.   Pneumo?
>
> All the time his CO2 was about 45 or so with a nice waveform.
>
> Also I don't see the correlation with the BP unless it was pure
> catecholamine related due to his dyspnea.
>
> Anxiety attack?
>
> I'm probably full of it, but that's all I can come up with.   Somebody HELP
> ME!   LOL.
>
> Gene G.
> In a message dated 6/29/09 7:57:53 AM, PMATERAMD@... writes:
>
>
>>
>>
>>
>> hi i cant see ecg either i will go by case presentation and vitals and
>> descriptions of the ecg by others,,, in general he is 48h sp surgery and
>> he
>> has plenty of bp therefore a direct cardiac cause of his sob is unlikey,
>> he
>> is sp surgery so pe is possible, he is struggling to maintain his O2
>> delivery with low pulse ox and reversible with O2 and peep point to a
>> pulmonary
>> parenchyma issue, pe, peumonitis, pneumonia, pneumo, pulmonary edema,
>> etc.,
>> he has a pulse and has excellent bp then this is unlikely a primary
>> cardiac
>> output issue and I would seriously resist any attempt at rate control with
>>
>> any med as this is likely to make the sob worse (ie reduce the already
>> reduced pulmonary perfusion) ie we dont try to fix what is not broke,
>>  any jvd filling from below, pulsus paradoxicus, sub q emphysema, etc
>>
>>  Paul
>>
>>  Paul A. Matera, MD, D-EM, D-IM, EMTP
>> Clinical Associate Professor - George Washington University, D.C.
>> Director Emeritus - Critical Care Units, Providence Hospital, D.C.
>>
>>
>>  In a message dated 6/28/2009 5:14:16 P.M. Eastern Daylight Time,
>> medicnick@... a messag
>>
>>  [Attachment(s) from Nikiah Nudell included below]
>>
>>
>> Second attempt for JD.
>> Thanks,
>> Nick
>>
>> ---------- Forwarded message ----------
>> From: Nikiah Nudell <medicnick@...>
>> Date: Sat, 27 Jun 2009 23:49:10 -0400
>> Subject: Hmmm
>> To: ekg_club@yahoogroupekg_c
>>
>> Attached you'll find a case of a 67 year old male two days post open
>> abdominal hernia repair. He experienced 45 minutes of sudden onset SOB
>> while
>> resting at home. Denies HA, CP, abd pain, or any symptom other than
>> difficulty breathing.
>>
>> His BP is 220/140, BGL 210, RR 40s, skin pale, warm/hot, moist. Airway is
>> patent although retractions are visible. Left lung sounds very diminished,
>> right side intially with wheezing changing to coarse rhonchi during care.
>>
>> 12lead, rhythm strip and EtCO2 attached. Past medical history of AAA with
>> aortic valve replacement & HTN reported. Patient takes coumadin, flomax,
>> lisinopril, and cardizem. Pt allergic to ASA and PCN.
>>
>> What say ye?
>>
>> Cheers,
>> Nick
>>
>> --
>> Sent from my mobile device
>>
>>
>>
>
> Make your summer sizzle with fast and easy recipes for the grill.
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> Make your summer sizzle with fast and easy recipes for the
> grill. (http://food.aol.com/grilling?ncid=emlcntusfood00000005)
>

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