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ECG Challenge: Double trouble

The patient appears anxious. His skin is pink, warm and moist. He states that his palpitations have “never been this bad” before.

Editor’s Note: Check out this month’s ECG case study and submit your treatment plan in the comments below. Get it right and you could win an EMS1 T-shirt and bottle opener. Good luck!

UPDATED: 11/22/2011 - Patient Follow-Up Posted. CLICK HERE FOR THE ANSWER

EMS is called to the residence of a 57-year-old male complaining of palpitations.

Past medical history: Palpitations “on and off” for the past two months. He was seen by a doctor and prescribed some medications.

Medications: Digoxin (Lanoxin) 0.125 mg, Propafenone (Rhythmol) 150 mg.

No known drug allergies.

The patient appears anxious. His skin is pink, warm and moist. He states that his palpitations have “never been this bad” before.

He denies chest discomfort or shortness of breath.

Breath sounds are clear bilaterally.

No JVD or pitting edema.

Vital signs are assessed.

  • RR: 18
  • Pulse: Very rapid
  • NIBP: 110/78
  • SpO2: 100 on room air

The patient is placed on the cardiac monitor which shows a narrow complex tachycardia at a rate of 261.

EMS1_2011_10_rhythm-SMALL.jpg

A 12-lead ECG is captured with the following computer measurements.

HR: 132
PR: 140
QRS: 94
QT/QTc: 290/416
P-QRS-T: -98 30 -78

EMS1_2011_10_12LEAD01-SMALL.jpg

How do you account for the difference in rate between the rhythm strip and the 12-lead ECG?

How would you treat this patient and why?

Tom Bouthillet, NREMT-P, is the battalion chief of EMS for Hilton Head Island Fire Rescue. He is a member of NHTSA’s High Performance CPR Working Group, program director of the South Carolina Resuscitation Academy, member of the Editorial Advisory Board of EMS World, content reviewer for the British Paramedic Journal, co-producer of the Code STEMI web series, and editor of EMS12Lead.com. Tom is interested in system performance, process improvement, and evidence-based performance measures for time-sensitive diagnoses.

He graduated with a paramedic/paramedicine degree from Parma Community Hospital EMS Education Program. 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.

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