Stump the Experts: The Case of the Tachy Trucker

Submitted by Tom Bouthillet
Submitted by Tom Bouthillet
We’re bringing back EP Lab Digest’s popular ‘Stump the Experts’ section. In this section, ECG images and a brief description are provided for readers. Can you identify the heart rhythm occurring in these ECGs? What should be the initial treatment? Send us your responses! We will publish the answer in next month’s issue. Part I. EMS is called to a truck stop for a 46-year-old male complaining of palpitations. On arrival, the patient is anxious but alert and oriented to person, place, time, and event. The onset of symptoms was sudden while the patient was fueling his tractor-trailer. He states that he has experienced palpitations before, but a recent 24-hour Holter monitoring did not reveal any significant arrhythmias. The patient denies chest discomfort, but admits to mild dyspnea. The patient’s skin is pink, warm, and moist. Vital signs are assessed. Resp: 20 Pulse: too rapid to count BP: 104/68 SpO2: 96 on RA Breath sounds: clear bilaterally The cardiac monitor is attached: SEE IMAGE 1 ABOVE A 12-lead ECG is captured: SEE IMAGE 2 ABOVE
Questions: 1.) How would you classify this tachycardia? 2.) How would you treat this patient? _______________________________
Part II. The paramedic in charge decided to treat this arrhythmia as a wide complex tachycardia of unknown etiology. Because the patient was determined to be hemodynamically stable, the paramedic’s protocol called for amiodarone 150 mg IV over 10 minutes. As the paramedic was mixing the amiodarone, he noted a rhythm change on the monitor: SEE IMAGE 3 ABOVE The patient reported some relief of his symptoms. Another 12-lead ECG was captured: SEE IMAGE 4 ABOVE The paramedic withheld the amiodarone and provided supportive care for the remainder of the transport.
Questions: 1.) What was the initial heart rhythm? 2.) Would amiodarone have been appropriate for this patient?
Tom Bouthillet’s Prehospital 12 Lead ECG blog (http://ems12lead.blogspot.com/) was featured in our March 2009 issue. Email your guesses to jelrod@hmpcommunications.com. The answers will be revealed in next month’s issue!