Would be interested in seeing that with a slower rate.
same, when i saw this my eyes went 😮
my EXACT reaction as well
I think it's rapid a-fib. I think the ischemic changes are due to the rate. Give them some #Amiodarone and see what happens when the rate sloes down.
amiodarone? ive never heard of that as a treatment option for afib ...im so use to seeing cardizem.
I tend to see amiodarone used more when you're sure it's a new onset and you want to try and convert it. If I wasn't sure how long the pt had been in/out of afib, I would expect cardizem titrated for rate control. Wouldn't want to convert if high risk for already developing a clot.
Cardizem where I work too.
take in entire clinical picture. Stable or unstable, new onset or old afib. Amio can be used to convert if new onset otherwise rate control with dilt or beta blocker gtt. If tenuous or unstable, shock. In this case specifically it is wide complex tachycardia so you probably want to treat as if could be vtach.
vtach? Rhythm is irregular. Look at the difference in #R-R-interval
yes it is likely afib with aberrancy however it is WIDE complex meaning use caution with nodal blocking agents. If this is wpw you will send patient into vfib. That is why you treat as if vtach.
Heard this before, when in doubt treat like vtac because it won't kill your pt. Thanks for explaining.
yes makes sense. Thanks!
would your amio dose for this be the standard 150mg over 10 minutes?
if stable with pulses, yeah.
#Amiodarone would be my first choice.
if this EKG is truly a wide complex tachycardia with a delta wave which I appears to be, then amio or CCBs would be a little risky if it blocks the AVN. Prefer Procainamide or DC cardioversion for those
This is a great EKG...Looks like afib with WPW conducting thru the kent bundle...for those suggesting amiodarone, amio could block the AV node and that can potentially lead to V Fib and death..
if sympamatic consider cardizem or cardio version. Maybe rvr afib
psvt with abberency
#Cardioversion would be the best choice here. It could be AF with pre-excitation (compare with my post from last week's #Imageoftheweek). Given the symptoms, I would not bother with drugs.
I wouldn't go straight for #Cardioversion since it's new onset. It looks like afib rvr. Cardizem gtt
the problem with that is that is that if it is AF with pre-excitation, cardizem would block the AV node and allow conduction through the accessory pathway. As a result, AF could degenerate to VF. Also add the fact that this is symptomatic unstable tachycardia with a pulse, cardioversion is ACLS protocol.
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