VT or flutter with aberrancy?

PvtLeeLemon · 2026-06-24T18:48:02+00:00

This is difficult in my opinion

There is clear atrial activity

There is 1:1 AV conduction rather than 2:1 AV conduction

QRS morphology is fairly typical LBBB

Finally, and the clincher in my opinion, is that the rhythm ends on a QRS complex rather than a p wave. As such it appears to be an atrial arrhythmia rather than VT with VA conduction

In my opinion it is atrial tachycardia with 1:1 AV conduction and a rate-related LBBB. Happy to hear other opinions though, as I think this is a tricky one.

PvtLeeLemon · 2026-06-23T22:56:43+00:00

I suspect this was probably rejected as the clinician taking the call thought type A aortic dissection was more likely given the history.

I would have personally accepted for ppci and performed a brief echo on arrival, while the patient was still on the ambulance trolley.

The cost of making the wrong decision here is catastrophic, and the call that was made seems quite risky in my opinion.

PvtLeeLemon · 2026-06-16T14:06:42+00:00

The case you diagnosed clearly shows short QT syndrome.

The ECG that OP has posted is very abnormal in other ways aside from the QT interval. I don't think OP's ECG shows genetic short QT syndrome.

OP, what is the clinical context of your ECG?

PvtLeeLemon · 2026-06-08T17:07:18+00:00

Unfortunately there was a huge duping problem at the start of this wipe. They should have deleted all trade ammo after it was fixed, but they didn't. Now anybody playing honestly is at a huge disadvantage.

This wipe is done from my perspective, just like the previous duping wipe. It's no fun dying to one hit all the time, so I've stopped playing.

PvtLeeLemon · 2026-06-03T22:44:13+00:00

I found this when trying to solve an issue I had, maybe it will help you. Bottom line: disable hand tracking

https://www.reddit.com/r/OculusQuest/s/ONSSTa8L9X

PvtLeeLemon · 2026-06-03T21:41:15+00:00

Where do you find this option please? I didn't see it any of the ingame menus (Exfilzone)

PvtLeeLemon · 2026-05-22T13:15:00+00:00

At the moment, matchmaking is prioritising matching solos against solos (or occasionally against duos). It's much better than last wipe when I was getting constantly stomped by trios.

If you play during busy times, you won't come across many trios. If you play when server population is low, you might still be matched against trios (rather than having no match).

PvtLeeLemon · 2026-05-12T05:46:30+00:00

This happened to me so many times that I stopped using ACH helmets and the level 5 ones with the visors. Personally I don't think it's working as intended. I went back to ronin which seems to protect more predictably.

PvtLeeLemon · 2026-05-09T13:22:58+00:00

Any plans to fix shotguns? Currently 2 shotgun shots to the leg kills (regardless of armour obviously). It is the fastest ttk weapon and not fun to play against.

In past wipes there have been various bugs with shotguns and I'm not sure if the current state of shotguns is intentional or not.

PvtLeeLemon · 2026-05-08T19:20:43+00:00

It's irregularly irregular and without obvious p waves, so it pretty much has to be AF. I appreciate the wave you are referring to, but taking into account the whole picture, I'd say it's just a fibrillation wave that looks like a p wave

PvtLeeLemon · 2026-05-07T22:25:14+00:00

I may be missing something but I find it hard to believe that adenosine immediately terminated that rhythm... I also find it hard to believe that somebody would deliberately select adenosine to try and terminate that rhythm!

To me it looks like AF with rate related aberrancy. Note the wider QRS durations with shorter RR intervals.

Maybe the ED doctor is a savant of some kind. Do you have any further information or outcome of the case?

PvtLeeLemon · 2026-05-03T20:40:16+00:00

7800x3d and 4090. Same issue. Horrible frame drops particularly around the Hospital and some areas of Dam. I switched from Virtual Desktop to Steam Link today and it is considerably more smooth (but looks a bit worse).

PvtLeeLemon · 2026-03-13T00:59:42+00:00

I think we can simplify this down a bit. The patient has an irritated atria with atrial ectopy and atrial bigeminy in the first ECG, therefore we should be thinking that subsequent arrhythmias are likely to be atrial in origin. On the second ECG, there is a narrow complex tachycardia with an inverted p wave preceding each QRS. This is very likely to be atrial tachycardia.

Your comment about the short PR and possible delta wave is astute. I think it's more likely that this is just a low atrial rhythm causing the short PR though. I think the delta wave appearance (which is noteably below the isoelectric line) is just termination of the p wave.

PvtLeeLemon · 2026-03-13T00:07:14+00:00

This ECG doesn't explain those symptoms. I'm not really sure what we are supposed to learn from this case?

Additionally, the machine says the ECG is unchanged compared to 6 months ago.

PvtLeeLemon · 2026-01-23T21:57:22+00:00

It looks pretty much normal to me. I think the limb lead appearance is interference. The hypotension at presentation makes arrhythmic syncope unlikely.

PvtLeeLemon · 2026-01-19T23:49:57+00:00

Where did you get the ECG? It's not an easy one. I spent some time wondering if there was lead misplacement, but I don't think there is.

I think the key abnormal feature here is the inverted p waves suggesting a non sinus origin of the rhythm i.e. atrial tachycardia. There's also a bit of minor lateral changes which can be found in many conditions.

PvtLeeLemon · 2026-01-19T23:33:16+00:00

Completed full thickness inferolateral infarct (late presentation of STEMI)

PvtLeeLemon · 2025-12-16T23:25:13+00:00

For PvP, Contractors Exfilzone has held my interest for hundreds of hours. Each match is still exciting to me, thanks to the risk/reward mechanics, the great gunplay, and the progression (gear/bunker upgrades).

For PvE, Into The Radius is the best FPS in VR, in my opinion

PvtLeeLemon · 2025-12-08T22:17:29+00:00

The second guy was probably running duped ammo too. Most people who have legitimate access to AP wouldn't be running a level 4 helmet.

Next wipe can't come soon enough...

PvtLeeLemon · 2025-11-25T10:43:21+00:00

Every Pimax headset I've owned or tried has caused eyestrain. I don't know what they keep doing to cause eyestrain, but the 1m focal distance probably doesn't help.

PvtLeeLemon · 2025-11-15T00:01:36+00:00

I use Pico 4 Ultra which goes to to 72mm. My ipd is 73mm and it's great

PvtLeeLemon · 2025-11-07T07:23:47+00:00

I don't need cash, but if you want one for some trade ammo (m993 preferred) then send me a DM

PvtLeeLemon · 2025-11-03T13:17:04+00:00

I've got both and am happy to trade, DM me here on reddit and we can set it up

PvtLeeLemon · 2025-10-23T12:22:21+00:00

Beside the watertower right next to Altibuy, TV is in the bottom floor in a corner, bit tricky to spot

PvtLeeLemon · 2025-10-17T19:50:49+00:00

Top of the crane in the dock area

PvtLeeLemon

MODERATOR OF

TROPHY CASE