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Home > EMS Products > Patient Monitoring
April 11, 2011
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EMS 12-Lead
by Tom Bouthillet

ECG Challenge: The path 'more' traveled

EMS is called to a hardware store for a 59-year-old male with palpitations

By Tom Bouthillet

Here's an interesting case submitted by Adam Thompson from Paramedicine 101. Some changes have been made to preserve patient confidentiality. EMS is called to a hardware store for a 59-year-old male with palpitations.

On arrival the patient is found sitting in a chair in the storeroom. He appears anxious. Skin is pink, warm and moist. He states that this has "happened before" but it's "been a while."

The patient is a poor historian. He states that he's seen a doctor for palpitations before and they "wanted to some kind of procedure but I said forget it!"



Vital signs:

RR: 14
Pulse: Extremely rapid and irregular
NIBP: 138/91
SpO2: Does not register

The patient denies chest pain or shortness of breath.

Breath sounds are clear bilaterally.

The cardiac monitor is applied.

How would you treat this patient and why?

About the author

Tom Bouthillet is a Fire Captain/Paramedic with Hilton Head Island Fire & Rescue, Editor of the EMS 12-Lead blog, host of the Code STEMI web series at First Responders Network, a member of the Editoral Advisory Board of EMS World Magazine, and developer of the 12-Lead ECG Challenge smartphone app. He has taught nationally in the Critical Care Transport (CCEMT-P) program out of UMBC and his writings have been referenced in the American Heart Journal, the Journal of the American College of Cardiology: Cardiovascular Interventions and the EP Lab Digest. Contact Tom at
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Roger Hancock Roger Hancock Wednesday, March 05, 2014 3:33:17 AM Prepare for cardioversion just in case. Oxygen 4L NC, 12 lead ecg, 10mg cardizem over 2 minutes and reassess repeat 10mg in 5 minutes if rhythm didn't convert.
Ebtehal Elzaki Ebtehal Elzaki Wednesday, March 05, 2014 4:23:05 AM this is AF due to WPW delta wave indicate accessory pathway so amiodarone or fleicanide and radiofrequency ablation
Branka Ilic David Branka Ilic David Wednesday, March 05, 2014 6:47:22 AM Attach monitor, i.v. route, Valsalva with deep breath, if slowdown try to differentiate that deformation at the beginning of R is it or not a delta wave,oxygen, and if you aren't sure amiodarone , maybe it will slowdown.
Valérie Gagnon Valérie Gagnon Friday, March 07, 2014 10:20:05 PM Multifocal Atrial Tachycardia there's at least 3 distinct P-wave morphologies in the same lead. You need to treat the underlying cause