Hi folks!
It begins. FOAMEd the basics in Emergency medicine & critical care series.
Dr Haney Mallemat, Assistant Professor of Emergency medicine, University of Maryland medical center, @CriticalCareNow
and me, @rfdsdoc
Tonight we bring you . TACHYARRHYTHMIAS
SHOW NOTE REFERENCES:
ECG used as example in presentation , courtesy of LITFL!
VT or not VT,that is the question!
WATCH VERY CAREFULLY! WE INSERTED A DELIBERATE ERROR INTO OUR DISCUSSION. CAN YOU PICK IT? SUBMIT YOUR ANSWERS TO WIN THIS MONTH’S PRIZE, SOMETHING ALL RESIDENTS/REGISTRARS/INTERNS SHOULD CARRY…THEIR OWN DISPOSABLE LED LARYNGOSCOPE!
Now on to the audio only Podcast
Right Click and Choose Save-as to Download the Podcast.
Prehospital and Retrieval Medicine - THE PHARM dedicated to the memory of Dr John Hinds 
The first ECG you shared is quite a bit faster than you indicated, at about 200 bpm. It also looks narrow on the surface, but it is actually bi-directional ventricular tachycardia – usually a result of dig-toxicity.
Thanks for the great review, and i’m looking forward to what else you have in store for this series.
thanks Vince.technically you win the prize but due to an unforseen gaff by @precordialthump, the answer was twittered an hour ago so renders the competition invalid !
Also are you sure that ECG rate is 200bpm?
Gah! When was the last time @precordialthump did anything useful for anyone?
Just kidding, and it’s not a problem. I went back to count complexes on the ECG and I’m seeing 34 QRS complexes on the 10 second tracing, for a rate of 204 bpm.
Using the large-box counting method I see 3 large boxes between each identical complex (every-other one), which would be a rate of 100 bpm, but then you double it to account for the QRS buried in-between, giving an estimate of 200 bpm again.
ok just checking..well done.
you got the deliberate errors, primary and secondary!
email me your mailing address and the Trulite MAC 4 LED laryngoscope is coming your way!
here is the LITFL blog post on this ECG.
http://lifeinthefastlane.com/2011/01/ecg-exigency-010/
nice podcast
whats your record for the number of boluses of amiodarone?
for APO / CCF and rapid AF, would you add magnesium to dig and amiodarone or would you worry that it might drop their BP?
three boluses my record for amiodarone loading but nowadays with combos rarely give amio boluses repeatedly before I get rate control
check out this RCT on mag and dig in rapid AF
Click to access AEM_45_p0347.pdf
yes hypotension can occur with Mag
Never given all three, amiod, dig and mag
usually give Mag with dig or amio but only if missing one or the other
my go to combo is amio and dig. never failed me yet.
thanks
we use dig and mag or amio and mag a lot where I work usually with good effect
did you ever get your hands on the pocket bougie?
Since I found the idea and references about Calcium pretreatment in AFib with Ca-Channelblockers I used it quite a bit on these “grayzone” patients, where you think they might not have much time, need agressive treatment or they go downhill…
Perhaps if you want to try before deciding for Amio (which might revert some) and since you only wanted to control rate, it might be the last secure “rate-only” control option.
So far very effective without badness in sight – to be considered!
Ref on Scott Weingart’s site: http://crashingpatient.com/medical-surgical/dysrhythmias.htm/
(Scroll to Afib – rate control)