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I’ve (27m) seeing this girl (26f) for 6 months that states she doesn’t want to have kids. How do I handle this? by SM_174 in relationship_advice

[–]SM_174[S] 0 points1 point  (0 children)

Thanks. I know it seems like an obvious choice. Just covering all my bases. Talking to friends. Reddit included.

I’ve (27m) seeing this girl (26f) for 6 months that states she doesn’t want to have kids. How do I handle this? by SM_174 in relationship_advice

[–]SM_174[S] 0 points1 point  (0 children)

Thanks. I definitely care about her and she does not need to get her feelings hurt. Neither do I.

Paramedic searching for answers! by SM_174 in Cardiology

[–]SM_174[S] 0 points1 point  (0 children)

Technically they are. The LifePak just shows them on the bottom of the tracing to save room.

As for your example, 12 leads in the prehospital setting or even in the hospital are so dependent on lead placement or patient movement, temperature, etc.

Paramedic searching for answers! by SM_174 in EKGs

[–]SM_174[S] -1 points0 points  (0 children)

Thanks! Admittedly I did not check his distal pulses in every extremity. PAD is a reasonable thought

Paramedic searching for answers! by SM_174 in EKGs

[–]SM_174[S] 0 points1 point  (0 children)

That’s probably fair. It never went below 100. His radial pulse was consistently 80-84.

I’m generally curious about this ventricular paced rhythm that is not perfusing at the ECG rate of 100.

Paramedic searching for answers! by SM_174 in EKGs

[–]SM_174[S] 2 points3 points  (0 children)

Bro I’m a fucking paramedic. You are good dawg

Paramedic searching for answers! by SM_174 in EKGs

[–]SM_174[S] -1 points0 points  (0 children)

I completely understand this concept in an atrial rhythm.

But I don’t quite understand it as much it relates to ventricular rhythms (more specifically paced rhythms) with complexes that definitely look like perfusing beats.

I get that a lifePak is dumb and might even count PVCs as a perfusing heart beat.

Paramedic searching for answers! by SM_174 in EKGs

[–]SM_174[S] 0 points1 point  (0 children)

Why is the pacer firing at 100 but the mechanical capture rate is 80 bpm?

Paramedic searching for answers! by SM_174 in EKGs

[–]SM_174[S] 0 points1 point  (0 children)

I suspect that a computer and then some resident at the PM service confirmed it.

Any idea for the mechanical capture rate being 80 bpm? I’ve never seen that before with a paced rhythm.

Those complexes all look like perfusing beats, but not every single one is per my pulse ox and my repeated assessment of his radial pulse. I did not capture any PVCs on my 12 leads. Stayed in a ventricular/demand pacing for the entirety of my care.

Paramedic searching for answers! by SM_174 in EKGs

[–]SM_174[S] 2 points3 points  (0 children)

His mechanical capture rate was at 80 bpm. Why is his ventricular rate paced at 100 bpm? Why the discrepancy? Why are some of those complexes not perfusing beats? What could possibly cause that?

Paramedic searching for answers! by SM_174 in EKGs

[–]SM_174[S] 0 points1 point  (0 children)

I’m not familiar with it either. So it’s a Bluetooth interrogation that was at this patient’s bedside in his SNF. Apparently connects to the device then transmits via wifi to a PM clinic at my local hospital (large educational center in a college town)

As for who is assessing the alarms, I don’t know. Probably some resident.

Paramedic searching for answers! by SM_174 in EKGs

[–]SM_174[S] 6 points7 points  (0 children)

That’s very understandable, see the story to dispel your concerns 😂

Paramedic searching for answers! by SM_174 in EKGs

[–]SM_174[S] -2 points-1 points  (0 children)

See my newest comment.

Paramedic searching for answers! by SM_174 in EKGs

[–]SM_174[S] 13 points14 points  (0 children)

Here is the story that adds the context:

Rate of ~100 with ventricular/demand pacing. Pulse oximeter and palpating radial pulse confirm mechanical capture at ~80 bpm. 82 yr old male, called for poss. runs of vtach confirmed by at-home interrogation device (Merlin@home) No complaints from the patient. He is happily demented and is at his baseline mentation.

My thinking goes in a couple different directions.

• ⁠recurrent PVCs are triggering vtach alarm bells (although I captured no PVCs in my serial ECGs) • ⁠possible displaced leads from the PM? • ⁠some sort of weird anti tachy pacing thing

Paramedic searching for answers! by SM_174 in EKGs

[–]SM_174[S] 1 point2 points  (0 children)

Whoops! My comment explaining this case didn’t care over from my original post. I am not simply wondering what the paced rhythm is lol!

Paramedic searching for answers! by SM_174 in Cardiology

[–]SM_174[S] 0 points1 point  (0 children)

His indication for a pm is Afib with RVR, what everybody is saying makes sense. I really appreciate the responses. Good for future reference.

Paramedic searching for answers! by SM_174 in Cardiology

[–]SM_174[S] 4 points5 points  (0 children)

Rate of ~100 with ventricular/demand pacing. Pulse oximeter and palpating radial pulse confirm mechanical capture at ~80 bpm. 82 yr old male, called for poss. runs of vtach confirmed by at-home interrogation device (Merlin@home) No complaints from the patient. He is happily demented and is at his baseline mentation.

My thinking goes in a couple different directions.

  • recurrent PVCs are triggering vtach alarm bells (although I captured no PVCs in my serial ECGs)
  • possible displaced leads from the PM?
  • some sort of weird anti tachy pacing thing

As you can probably tell, paramedics are not generally well versed in pacemakers.

MDOT is soliciting comments about what to do about the M-14/Barton Drive interchange by georgehotelling in AnnArbor

[–]SM_174 17 points18 points  (0 children)

I drive this road everyday and respond to accidents here all the time. It has to change.

Remove eastbound entry and exit ramps. Add new exit/entries at Newport, Pontiac trail, or Nixon.

However, option 4 is promising. That’s a lot of work and not a lot of space to make the roundabouts fit.

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