Here’s a call that was very well executed.
The patient was a 35 year old Hispanic female; walk-in patient at a volunteer clinic.
Through an interpreter it was learned that the patient was complaining of palpitations and slight chest discomfort.
The onset was sudden.
The medical history was significant for “arrhythmias”.
Skin: warm and dry with pink oral mucosa
Vital signs were assessed.
Pulse: Too rapid to count
SpO2: 97 on RA
The cardiac monitor was attached.
A 12 lead ECG is captured.
Once the arrhythmia resolves (on its own or with our help) the opportunity to document the arrhythmia is gone.
The 12 lead ECG can be invaluable to the cardiologist/electrophysiologist who follows up on the patient!
It can also be invaluable to YOU when you’re trying to figure out what you’re dealing with.
The patient was placed on oxygen.
An IV was started and labs were drawn.
The paramedic in charge of the call reviewed the Hs and Ts and found no evidence that it was a compensatory tachycardia.
6 mg adenosine was given rapid IV push followed by a 20 ml bolus of 0.9% NS.
The paramedic remembered to press the PRINT button prior to giving the drug.
The following two rhythm strips are continuous.
As a side note, I like to show these rhythm strips to new paramedics and ask them to interpret the heart rhythm.
Since the monitor was already attached, it was a simple matter to capture a post-conversion 12 lead ECG.
Narrow complex tachycardias – Part II