Static Cardiology Scenarios #1
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- Опубликовано: 26 авг 2024
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Our video reviews what the Paramedic student can expect to see on test day during their NREMT practical exam.
This video is specifically provided by EMTprep to assist Members in preparing for the NREMT exam and related skills sheets and for no other purpose. NREMT study aids and resources provided by EMTprep are not intended to provide training for life saving techniques, emergency response training, or any other type of medical training.
As a graduate preparing for static EKGs there are several things to consider. Although treatment is based on ACLS you cannot prepare for grader bias and opinion. You can only prepare yourself.
The best practice is to be thorough and fast, taking into consideration your testing anxiety level. If you experience anxiety that causes performance issues you may need a different strategy. In this case prepare and study simple parrot phrases for each ACLS algorithm. (I suggest simple treatment like “start an IV” as opposed to detailing the equipment used and technique starting the IV. Etc.) Once you identify the rhythm and patient conditions quote the memorized card treatment then let the evaluator know you are finished with that strip.
As the video shows be prepared for non-cardiac patients also. Your 4 test strips may include 1 or more 12 leads requiring basic 12 lead interpretation.
Rhythm #3 is an agonal rhythm and clinically is considered asystole. Either way, PEA and asystole are the same tx. Just wanted to mention.
So, you don't see the fine vfib?
Please....more &more videos like this.....wonderful &v.good efforts 👌
Awesome!
#3 it may be stating the obvious, but for high quality cpr I'd specify to use a backboard or the floor, since he's lying on the couch
I figured #3 was Fine V-Fib w/an ectopic or agonal beat. If that's even possible. Love these vids! Super helpful.
Same here! I also thought it was fine V-fib with an agonal beat. But then again for testing purposes, if it is electrical activity with no pulse and NOT organized its PEA. If its organized it is either v-fib or v-tach
I'm in the comments for the same and I agree with you.
@@thisgirlripslips This is definitely fine vfib with an agonal beat. PEA is defined as an organized rhythm with a pulse such as IVR, sinus brady, etc.
Doesn't the ACLS vfib protocol recommend epi starting after the second shock and amio after the third?
scenario #2 looks like torsades, but is it only torsades if they have a pulse? v-fib otherwise?
No, torsades is more of a winding rhythm. Tough to tell with a shorter rhythm strip, but it appears to be standard v-fib. Torsades can be with a pulse or pulseless.
vfib doesnt have a pulse correct? torsades might have one, might not.. if they do then it is thready and hard to palpate
good replies. i said torsades first.
so torsades is either pulse or pulseless?
and v fib doesnt have a pulse?
thanks
GrahamDyck Vfib never has a pulse. The ventricles are just quivering so no blood is being circulated. Torsades is just polymorphic vtach. If it doesn’t have a pulse it’s treated like monomorphic vtach. You usually will never see pulseless torsades though because by that time it has already progressed to vfib.
I thought the same, it looks like Torsades!
Why would you treat with oxygen if patient is sating 100%?
Could be preventative
Because it’s the NREMT my dude. According to the NREMT high flow o2 will cure cancer.
This is stupid. They need to change their thinking from “how much O2 should I give” to “SHOULD I give O2”.
It actually is not anymore it hasn't been like that for at least 2 years
Because NREMT is special
This is fantastic content. Much obliged!
Thanks Devin!
Thank you. Good learning video
please share a dynamic cardiology station too
Q. Scenario 2: Shouldn't you defibrillate as soon as the pads are on so you don't lose the opportunity in the event that V-fib turns to A-systole while completing the 2 minutes of chest compressions? Once that opportunity is gone, it's more difficult to get it back.
Some sources recommend one round of compressions before defibrillation if the arrest is unwitnessed or if CPR wasn't started by bystanders. The idea is that the cycle of compressions will reperfuse the cardiac muscle and make metabolic conditions more conducive to defibrillation.
For #2, aren't you supposed to do Amio *or* Lidocaine ... not both (per ACLS algorithm)?
That's what I thought, too. But I can't find that anywhere, just remember being told pick one. That'd be one I'd want expert consultation on before administering.
@@ajaxdonqueso9597 Look up the ACLS 2020 Cardiac Arrest algorithm. One of my instructor also mentioned it. She said to pick one that you know the dosage of... and stick with it.
awesome thank you
For your sinus Brady 1st degree heart block, would you consider atropine or even pace the patient?
For your exam, you should consider stating both, as they're protocol dependent. That would also show the proctor you know a couple different options.
@@Emtprep thank you! I test on Sunday!
@@jsrahman03 remember, for atropine and pacing they need to be symptomatic and then you need to consider if stable vs unstable. check you local protocols, but at least here in NY, were only giving atropine if bradycardic and symptomatic. In that scenario, other than nausea (likely from drinking) he was stable with no hemodynamic compromise, so atropine or pacing wouldnt be indicated, as speeding up his heart rate(which appears to be apprx 65BPM) vs a fluid bolus to bring his BP (*closer to 120 systolic) due likely to his vomiting over 2 days & Zofran would be the correct initial choices of treatment, as stated in the scenario.
I have not examined a strip in 40 years,
But strip #1 looks like a regular irregularity. I also see p waves in the lower view marching across the strip.
I'll go with 3rd degree block as possible ... but a fib is more likely.
I work in cardiology. It's Afib. The P waves that you think you're seeing are not the same in every beat, making it unlikely that this is a sinus rhythm with heart block because it's unlikely those waves are coming from the SA node. The baseline artifact is also another classic finding with Afib on an EKG
thanks for actual scenarios!
Why it's always 8 second strip? #3 scenario I don't think it's PEA, it's like agonal beat, treated the same as PEA but not it
it is PEA because there is no pulse.. that underlying rhythm to me looks like a idioventricular rythm but there is no pulse so answer would be PEA
Agreed, it is agonal due to the lack of any electrical activity except the occasional uncoordinated wide QRS-like wave. Clinically, agonal rhythms are considered asystole.
great video thanks
scenario #1 Afib with RVR with generalised weakness should prompt you to give Diltiazem immediately, not waiting until they become symptomatic. Correct before it complicates not after.
The rate doesnt appear to be the issue. This patient may live with afib and I dont believe the rate is fast enough, she could be compensating for something as well, like an infection and we would take the compensating factor away.
Lol look at the lines 300,150,100,75 its like 70 something its compensated a-fib good sir
Ditiazem is only given whe the AFib has rapid ventricular response above 150 HR, and there are not other causes to treat, or is the first time patient is exhibiting VFib to avoid accumulation and coagulation of blood in the atria. This HR is not fast enough, BP is whitin normal limits, patient is not AMS, etc. It's compensated, you don't treat rapid AFib when is compensated, you treat the causes, or it may be pt's baseline.
That's a lot of info to say in your minute and a half your are given
Failed,though #2 was pulseless VT
Same at first but v tach would be more organized and tighter. I’d almost argue it’s torsodes but I’d need a longer strip to call it that.
it's a Coarse Vfib
Don't forget capnography/capnometry for cardiac arrests.
Scenario 1 has some pretty obvious p waves in lead III... I'd go with sinus rhythm/arrhythmia with trigeminal PACs. The other leads present with artifact which is why I'm guessing y'all went with afib?
Nope.
it's A-Fib homie, try not to overthink it
That is correct, sinus rhythm with PACs if you guys can't see that we are in trouble
@@valentioliveras1637 all good if you can't quite see it. were all medics, were all out here.
@@valentioliveras1637 there's no discernable p waves, they don't March out in any lead, you can argue and say (it's just artifact) but that's not the case in this instance as it doesn't indicate any artifact is reflecting on the ecg in the scenario. the R-R intervals are irregular, and the isoelectric line is wonky af. it's A-Fib.