Read this ECG

[Bobrichards101]

I'd like to see what y'all make of this ECG, what arrhythmia(s) is/are present?

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[deleted547339]

What's the K?

 

[dotcb]

Vital signs, complaint? Pacer pads on...

 

[Bobrichards101]

What's the K?

No data on potassium, it's not mine.

 

[Bobrichards101]

Vital signs, complaint? Pacer pads on...

I don't have 'em, look purely at the graph. I'm leaning towards accelerated idioventricular rhythm.

 

[Bobrichards101]

Vital signs, complaint? Pacer pads on...

Oh, and no pacer. Neither brady nor tachycardia was present in this patient according to the medic that gave me this picture.

 

[Doctor Bob]

That looks like an abnormal EKG...

 

[McSap]

rate looks a little fast for accelerated idioventricular rhythmn, hard to tell exact rate from the photo, but looks to be >120

VT vs a supraventricular rhythm with LBBB or pre-excitation: cant see any obvious evidence of atrial activity although there is ?some beat to beat variation in the QRS most noticeable in V4 which might just be buried p waves (or maybe flutter waves)??? There is a lack of concordance in the precordial leads, although that doesnt really rule out VT.

Is the rate 150? -> thinking atrial flutter 2:1 block with either LBBB or pre-excitation.

 

[sluggs]

Call me a simple dummy, but VT??

 

[jdh71]

EKG dorks . . .

Does it matter outside of context? What is going in with the patient?

 

[mrpankration]

This is a regular, wide-complex tachycardia. I'll save the mental masturbation for the cardiology wanna-bes.

 

[Hernandez]

This is a regular, wide-complex tachycardia. I'll save the mental masturbation for the cardiology wanna-bes.

Stable or unstable? Is other thing that need to be known.

 

[greatnt249]

Wouldn't think idioventricular rhythm would produce such a wide QRS complex, but then again, I could be wrong. Given the absence of any and all other pertinent medical history as well as vitals, would venture that this is most likely either monomorphic ventricular tachycardia (apparently stable enough to get a 12-lead on) or some sort of SVT with aberrant conduction.

 

[dotcb]

Bobrichards 101 - Are you going to give us the conclusion?

 

[DocRGR]

I'll play...VT, hyperK, tox? Bicarb, Ca, pads and electricity with a little sedation if possible. I'm with Doctor Bob and JDH, it's abnormal and my first 3 seconds looking at the patient is largely going to dictate management.

 

[Bostonredsox]

Agree with hern, unstable or stable. If k is normal, I'm calling it VT. Wide complex and regular, all the precordial qrs complexes are concordent. If unstable I'm shocking if not I'm giving amio.

 

[Hernandez]

Agree with hern, unstable or stable. If k is normal, I'm calling it VT. Wide complex and regular, all the precordial qrs complexes are concordent. If unstable I'm shocking if not I'm giving amio.

....and call cardiology.....most important part in cases goes to a jury.

Ahhh. Brings back memories. I once had a cards fellow tell me they didn't appreciate being pages multiple times over a pt. to which I not so nice replied not giving a damn what they did or didn't appreciate. Pt had sudden on set hypotension and acute ST changes (which I'm sure had something to do with the dopamine on top of PTs bad AS not my doing but I digress) they came over finally and were pontificating something about reentey something or other and I glazed over from it being 3am, bring hypocaffinemic, and of ****s to give Sorry kid, EKG changes hemodynamic instability and that's all on you to decide what's wrong with ticker while I stabilize as much as I can.