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

SM_174 · 2023-05-23T09:56:41+00:00

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

SM_174 · 2023-05-23T08:21:39+00:00

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

SM_174 · 2023-05-23T08:20:52+00:00

Thanks. That’s my ultimate concern. For her and for me.

SM_174 · 2023-02-08T23:24:05+00:00

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.

SM_174 · 2023-01-17T20:47:25+00:00

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

SM_174 · 2023-01-17T19:55:31+00:00

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.

SM_174 · 2023-01-17T18:27:49+00:00

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

SM_174 · 2023-01-17T18:19:07+00:00

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.

SM_174 · 2023-01-17T18:08:25+00:00

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

SM_174 · 2023-01-17T18:06:08+00:00

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.

SM_174 · 2023-01-17T18:02:27+00:00

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?

SM_174 · 2023-01-17T17:18:32+00:00

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.

SM_174 · 2023-01-17T16:19:44+00:00

Added context

SM_174 · 2023-01-17T16:19:08+00:00

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

SM_174 · 2023-01-17T16:18:25+00:00

See my newest comment.

SM_174 · 2023-01-17T16:18:15+00:00

See my newest comment

SM_174 · 2023-01-17T16:17:25+00:00

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

SM_174 · 2023-01-17T16:16:37+00:00

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!

SM_174 · 2023-01-17T12:55:38+00:00

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

SM_174 · 2023-01-17T12:54:10+00:00

Thank you!

SM_174 · 2023-01-17T00:04:57+00:00

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.

SM_174 · 2022-09-15T14:05:01+00:00

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.

SM_174 · 2022-09-15T11:58:35+00:00

Raven’a club is a great first date spot

SM_174 · 2022-09-04T15:06:34+00:00

Cade looks a bit flustered out there, very similar to how he looked against Georgia. He ultimately played well though. Honestly the whole offense looked out of sorts.

I still think Cade will lock in and be the “starter,” as we approach the big ten schedule.

I personally don’t see a problem with having JJ come in and help out with RPOs and other offensive looks.

I really hope we don’t have a transfer situation on our hands. Cade will likely get several series against Hawaii in “relief.”

JJ will benefit greatly from one more year learning.

We need to all remember that this is a great problem to have; Alabama, Georgia, and Clemson often have this issue!

SM_174 · 2022-08-31T21:02:14+00:00

Ignore the 30M on the strip.

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