I’m not quite sure what this rhythm is…

“Umm, can I have a doc in this room? ” The nurse was casual and collected.  But anytime a nurse asks, “Can I have a doc in here?” you can be pretty certain there is some excitment in your near future. She & I alternated glances between the patient and the monitor. Patient:  awake but confused.  Monitor: Rapid heart rate, undetermined rhythm. The nurse said, “I thought she may have been in vfib for a second, but she looks OK now.”   For a brief moment I felt all knowledge leave my brain. I was unable to neatly categorize this patient into a diagnostic box.  We knew nothing about her.  The paramedics brought her in on a stretcher, provided no history and said, “She’s fine,” then they left. As I ran out of the room to pull up an old EKG looking for a similar tachycardic rhythm the nurse rapidly stuck leads to the patients chest to run a 12 lead.  I scanned through her old EKG images as if I were playing a game of concentration with a deck of children’s playing cards…no 2 EKG images looked alike.  Fast, slow, narrow complex, wide complex…did this woman have any EKGs that looked “normal”? The new EKG looked nearly identical to one I pulled up from a few months ago.  Rapid Atrial Fibrillation.  I was relived.  Her blood pressure was in the 160s…plenty of room for some calcium channel blockers to slow her heart rate down.  The only thing I didn’t have an explanation for w...
Source: Mr. Hassle's Long Underpants - Category: Emergency Medicine Authors: Tags: Clinical Uncategorized Source Type: blogs