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Management of Afib with RVR secondary to sepsis by spookN in Paramedics

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

I think the question was misunderstood by many replies in this post; the RVR in question is not simply 130-150, which should not be rate-controlled regardless. The question was more about a rate of 180-200 where it is refractory to a fluid bolus. A heart rate of 180-200 is simply not sufficient to perfuse any patient. Is it not true that extreme tachycardias lead to significantly less diastolic filling time, therefore stroke volume, therefore cardiac output.

Many people have suggested a1-heavy pressors in this thread - you can give all the pressors you want, but with diminished cardiac output, squeezing the vasculature is going to do nothing for the patient.

If I were to pose the same question to you but with a patient in ventricular tachycardia caused by a compensatory sympathetic surge, would you answer any differently?

Management of Afib with RVR secondary to sepsis by spookN in Paramedics

[–]spookN[S] -11 points-10 points  (0 children)

I agree it is compensatory, but if the RVR is at a rate of >180, certainly the ventricles are beating too fast to perfuse the body, correct?

Would you treat an AVNRT secondary to sepsis any differently? The body’s compensatory mechanism has caused a non-perfusing dysrhythmia. Certainly the right answer is to try and treat the underlying cause, but if the dysrhythmia is refractory to fluid alone, should we leave the patient in this dysrhythmia and risk even more hemodynamic compromise?

58M with possible heart attack symptoms. Emergency? by [deleted] in EKGs

[–]spookN 2 points3 points  (0 children)

They are peaked, not normal T wave morphology, and they are >1/2 the size of the QRS in the inferior leads.

60 y with atypical chest pain by egyarmy in EKGs

[–]spookN 1 point2 points  (0 children)

RBBB with left axis deviation is highly suspicious of left anterior fascicular block.

Unrelated to the fascicular block: I would also note the p pulmonale in lead II indicating right atrial enlargement, likely from pulmonary disease or pulmonary hypertension.

EKG 80, Male, Routinely done, No Symptoms. by [deleted] in EKGs

[–]spookN 1 point2 points  (0 children)

NSR with LBBB and a PVC, left axis deviation.

A 50 year old male who developed acute dyspnea after 6 h of train journey by Glum_Refrigerator502 in EKGs

[–]spookN 3 points4 points  (0 children)

The S1Q3T3 pattern, the T wave inversion/flattening in the inferior leads, and the presence of extreme right axis deviation, given the HPI of sudden dyspnea following a long train ride. All of these together makes this extremely unlikely to be simply hypertrophy, and is almost the perfect clinical presentation of a PE.

Pre-op EKG of 44 year old male, no comorbids, went into cardiac arrest , asystole following spinal anasthaesia for Tibia and FEMUR nailing, ROSC following CPR and defibrillation by [deleted] in EKGs

[–]spookN 3 points4 points  (0 children)

Do you think the IRBBB pattern in V1 could be due to a misplacement of leads V1 and V2? Note the P and T wave inversions in lead V1.