A paramedic crew responded to the office of a local physician. A 61-year-old male presented with a one-week history of chest pain and shortness of breath.
A good example of ventricular fibrillation converted by electric defibrillation to what appears to be a sinus rhythm. There is significant artifact in the post-conversion strip, but the last beat on the strip appears to have a P-QRS-T sequence.
Of course, V Fib presents without pulses, and must be defibrillated as soon as possible. Best results are achieved by defibrillating a perfused heart, so if there is any delay from onset of V Fib, CPR should be performed to perfuse the heart prior to defibrillation.
A good example of ventricular fibrillation. The patient is pulseless, CPR has been performed, and the ED staff is about to defibrillate. Characteristics of V Fib are: a chaotic, wavy baseline without clear P waves, QRS complexes, or T waves. Baseline artifact (baseline going up and down) can be seen with CPR and other movement of the electrodes on the patient's body as resuscitation efforts are underway. The patient will ALWAYS be unconscious and pulseless in V Fib.
This is a rhythm strip from a NIPS procedure (non-invasive programmed stimulaltion), which is a programming test for an implantable cardioverter defibrillator (ICD). The test is done under light anesthesia, similar to that used for colonoscopy. In this example, the patient is in normal sinus rhythm at the beginning of the procedure. The pacemaker technician overdrives the patient's rate to observe the pacing function, then a stimulus is delivered to cause ventricular fibrillation (V Fib).
Chances are that just the mere sight of the 12-lead ECG above has already piqued your interest in what will follow! It was recorded during an actual code-blue and the patient expired a short time later but I'm posting it here in order to graphically illustrate my point. Incidentally, the above ECG was diagnosed by my former Chief of Cardiology as "
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