Hope to see some of my Florida friends at ClinCon in Orlando next month. I will be presenting two "Pure Practice" ECG classes: A four-hour look at conduction blocks on Monday, July 10th and a one-hour session on subtle M.I. recognition. Pure Practice is fun - it is an instructor-guided practice session where you have a chance to discuss interpretation and management with a small group, using real ECGs. It is very informal and collegial. There are many other great courses and presentations, as well as the ACLS/BLS competition.
This patient is a 50-year-old man with a history of epilepsy and early dementia. He had a VP shunt placed in the hospital and was then discharged home. He became extremely weak, which was not characteristic of him, and 911 was called. He was transported to the hospital uneventfully. He was found to be afebrile.
This strip shows a junctional rhythm at a rate of 110 beats per minute. The QRS complexes are slightly wide at .10 seconds (100 ms), and they are within the parameters for supraventricular rhythm. The term, "junctional tachycardia" could be used, also, but this is not likely a "reentrant" junctional tachycardia, which would be fast, regular, and have a sudden onset. That type of junctional tachycardia is a PSVT. In this strip, we can see the underlying sinus rhythm in P waves that appear to pop up randomly.
This series of two ECGs was obtained from a 41-year-old woman who was brought to the Emergency Department and subsequently suffered cardiac arrest. ECG no. 1 is pre-arrest and ECG no.
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