Re: Torsades, Or Not Torsades...

[Guest guest]

First question. Does she have a pulse?

G

Torsades, Or Not Torsades...

Alright... Woman comes to the doctor for shortness of breath and chest pain.

The chest pain got worse while she was there, and they called 911. We arrive on

scene. This is her 3-lead.

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo.\

jpg

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

1.jpg

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

2.jpg

She has a history of angina and htn.

And, I was talking to this cute EMT, and he thinks this rhythm is V-Fib. I

believe it to be Torsades Des Pointes.

So, let's take a vote...

Torsades?

V-Fib?

FUR?

Alyssa Woods, NREMT-B

CPR Instructor

Sent from the itty bitty keyboard on my iPhone

[Guest guest]

The real question is did you get the cute EMT's number.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typos.

(Cell)

LNMolino@...

> Alright... Woman comes to the doctor for shortness of breath and chest pain.

>

> The chest pain got worse while she was there, and they called 911. We arrive

on scene. This is her 3-lead.

>

>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo.\

jpg

>

>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

1.jpg

>

>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

2.jpg

>

> She has a history of angina and htn.

>

> And, I was talking to this cute EMT, and he thinks this rhythm is V-Fib. I

believe it to be Torsades Des Pointes.

>

> So, let's take a vote...

>

> Torsades?

> V-Fib?

> FUR?

>

> Alyssa Woods, NREMT-B

> CPR Instructor

>

>

> Sent from the itty bitty keyboard on my iPhone

>

> ------------------------------------

>

>

[Guest guest]

We didn't check while she was in it, but she was conscious and had a pulse

before and after she was in it.

Alyssa Woods, NREMT-B

CPR Instructor

Sent from the itty bitty keyboard on my iPhone

> First question. Does she have a pulse?

>

> G

>

> Torsades, Or Not Torsades...

>

> Alright... Woman comes to the doctor for shortness of breath and chest pain.

>

> The chest pain got worse while she was there, and they called 911. We arrive

on scene. This is her 3-lead.

>

>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo.\

jpg

>

>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

1.jpg

>

>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

2.jpg

>

> She has a history of angina and htn.

>

> And, I was talking to this cute EMT, and he thinks this rhythm is V-Fib. I

believe it to be Torsades Des Pointes.

>

> So, let's take a vote...

>

> Torsades?

> V-Fib?

> FUR?

>

> Alyssa Woods, NREMT-B

> CPR Instructor

>

>

> Sent from the itty bitty keyboard on my iPhone

>

>

>

>

[Guest guest]

Oh, I've had the cute EMT's number. And address. And where he's going to school.

He wasn't on this call; this was one I immediately turned and sent to him...

Alyssa Woods, NREMT-B

CPR Instructor

Sent from the itty bitty keyboard on my iPhone

> The real question is did you get the cute EMT's number.

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/EMSI

> Typed by my fingers on my iPhone.

> Please excuse any typos.

> (Cell)

> LNMolino@...

>

>

>

> > Alright... Woman comes to the doctor for shortness of breath and chest pain.

> >

> > The chest pain got worse while she was there, and they called 911. We arrive

on scene. This is her 3-lead.

> >

> >

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo.\

jpg

> >

> >

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

1.jpg

> >

> >

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

2.jpg

> >

> > She has a history of angina and htn.

> >

> > And, I was talking to this cute EMT, and he thinks this rhythm is V-Fib. I

believe it to be Torsades Des Pointes.

> >

> > So, let's take a vote...

> >

> > Torsades?

> > V-Fib?

> > FUR?

> >

> > Alyssa Woods, NREMT-B

> > CPR Instructor

> >

> >

> > Sent from the itty bitty keyboard on my iPhone

> >

> > ------------------------------------

> >

> >

[Guest guest]

You're closer than he is, but not 100% correct. The best you can do with

the strip in question is to call it polymorphic VT.

To make a definitive diagnosis of Torsades, you have to have a prolonged

QT interval, and you can't measure a QT interval while they're in VT.

You have to wait until the rhythm breaks to measure the baseline QTI.

>

> Alright... Woman comes to the doctor for shortness of breath and chest

> pain.

>

> The chest pain got worse while she was there, and they called 911. We

> arrive on scene. This is her 3-lead.

>

>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo.\

jpg

>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo\

..jpg>

>

>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

1.jpg

>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo\

-1.jpg>

>

>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

2.jpg

>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo\

-2.jpg>

>

> She has a history of angina and htn.

>

> And, I was talking to this cute EMT, and he thinks this rhythm is

> V-Fib. I believe it to be Torsades Des Pointes.

>

> So, let's take a vote...

>

> Torsades?

> V-Fib?

> FUR?

>

> Alyssa Woods, NREMT-B

> CPR Instructor

>

>

> Sent from the itty bitty keyboard on my iPhone

>

>

--

Grayson, CCEMT-P www.kellygrayson.com

[Guest guest]

While I know that conscious = pulse isn't an absolute since noting in medicine

is (at least not on this list) it's a relatively safe bet.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typos.

(Cell)

LNMolino@...

> conscious

[Guest guest]

An EKG strip used as a pick up line has to be a first.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typos.

(Cell)

LNMolino@...

> Oh, I've had the cute EMT's number. And address. And where he's going to

school.

>

> He wasn't on this call; this was one I immediately turned and sent to him...

>

> Alyssa Woods, NREMT-B

> CPR Instructor

>

>

> Sent from the itty bitty keyboard on my iPhone

>

>

>

>> The real question is did you get the cute EMT's number.

>>

>> Louis N. Molino, Sr. CET

>> FF/NREMT/FSI/EMSI

>> Typed by my fingers on my iPhone.

>> Please excuse any typos.

>> (Cell)

>> LNMolino@...

>>

>>

>>

>>> Alright... Woman comes to the doctor for shortness of breath and chest pain.

>>>

>>> The chest pain got worse while she was there, and they called 911. We arrive

on scene. This is her 3-lead.

>>>

>>>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo.\

jpghttp://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

1.jpghttp://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

2.jpg

>>>

>>> She has a history of angina and htn.

>>>

>>> And, I was talking to this cute EMT, and he thinks this rhythm is V-Fib. I

believe it to be Torsades Des Pointes.

>>>

>>> So, let's take a vote...

>>>

>>> Torsades?

>>> V-Fib?

>>> FUR?

>>>

>>> Alyssa Woods, NREMT-B

>>> CPR Instructor

>>>

>>>

>>> Sent from the itty bitty keyboard on my iPhone

>>>

>>> ------------------------------------

>>>

>>>

[Guest guest]

" Hey, baby... Maybe this is the caffeine talking, but you're looking a little

tachy... "

Alyssa Woods, NREMT-B

CPR Instructor

Sent from the itty bitty keyboard on my iPhone

> An EKG strip used as a pick up line has to be a first.

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/EMSI

> Typed by my fingers on my iPhone.

> Please excuse any typos.

> (Cell)

> LNMolino@...

>

>

>

> > Oh, I've had the cute EMT's number. And address. And where he's going to

school.

> >

> > He wasn't on this call; this was one I immediately turned and sent to him...

> >

> > Alyssa Woods, NREMT-B

> > CPR Instructor

> >

> >

> > Sent from the itty bitty keyboard on my iPhone

> >

> >

> >

> >> The real question is did you get the cute EMT's number.

> >>

> >> Louis N. Molino, Sr. CET

> >> FF/NREMT/FSI/EMSI

> >> Typed by my fingers on my iPhone.

> >> Please excuse any typos.

> >> (Cell)

> >> LNMolino@...

> >>

> >>

> >>

> >>> Alright... Woman comes to the doctor for shortness of breath and chest

pain.

> >>>

> >>> The chest pain got worse while she was there, and they called 911. We

arrive on scene. This is her 3-lead.

> >>>

> >>>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo.\

jpg

> >>>

> >>>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

1.jpg

> >>>

> >>>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

2.jpg

> >>>

> >>> She has a history of angina and htn.

> >>>

> >>> And, I was talking to this cute EMT, and he thinks this rhythm is V-Fib. I

believe it to be Torsades Des Pointes.

> >>>

> >>> So, let's take a vote...

> >>>

> >>> Torsades?

> >>> V-Fib?

> >>> FUR?

> >>>

> >>> Alyssa Woods, NREMT-B

> >>> CPR Instructor

> >>>

> >>>

> >>> Sent from the itty bitty keyboard on my iPhone

> >>>

> >>> ------------------------------------

> >>>

> >>>

[Guest guest]

I remember being taught in school that It’s only torsades if it’s

paroxysmal. Otherwise, it’s polymorphic VT.

From: texasems-l [mailto:texasems-l ] On Behalf

Of Alyssa Woods

Sent: Thursday, September 02, 2010 7:45 PM

To: texasems-l

Subject: Re: Torsades, Or Not Torsades...

" Hey, baby... Maybe this is the caffeine talking, but you're looking a little

tachy... "

Alyssa Woods, NREMT-B

CPR Instructor

Sent from the itty bitty keyboard on my iPhone

On Sep 2, 2010, at 7:40 PM, " Louis N. Molino, Sr. " lnmolino@...

> wrote:

> An EKG strip used as a pick up line has to be a first.

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/EMSI

> Typed by my fingers on my iPhone.

> Please excuse any typos.

> (Cell)

> LNMolino@...

>

> On Sep 2, 2010, at 19:29, Alyssa Woods amwoods8644@...

> wrote:

>

> > Oh, I've had the cute EMT's number. And address. And where he's going to

school.

> >

> > He wasn't on this call; this was one I immediately turned and sent to him...

> >

> > Alyssa Woods, NREMT-B

> > CPR Instructor

> >

> >

> > Sent from the itty bitty keyboard on my iPhone

> >

> > On Sep 2, 2010, at 7:27 PM, " Louis N. Molino, Sr. " lnmolino@...

> wrote:

> >

> >> The real question is did you get the cute EMT's number.

> >>

> >> Louis N. Molino, Sr. CET

> >> FF/NREMT/FSI/EMSI

> >> Typed by my fingers on my iPhone.

> >> Please excuse any typos.

> >> (Cell)

> >> LNMolino@...

> >>

> >> On Sep 2, 2010, at 19:19, Alyssa Woods amwoods8644@...

> wrote:

> >>

> >>> Alright... Woman comes to the doctor for shortness of breath and chest

pain.

> >>>

> >>> The chest pain got worse while she was there, and they called 911. We

arrive on scene. This is her 3-lead.

> >>>

> >>> http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo\

..jpg> &current=photo.jpg

> >>>

> >>> http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo\

-1.jpg> &current=photo-1.jpg

> >>>

> >>> http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo\

-2.jpg> &current=photo-2.jpg

> >>>

> >>> She has a history of angina and htn.

> >>>

> >>> And, I was talking to this cute EMT, and he thinks this rhythm is V-Fib. I

believe it to be Torsades Des Pointes.

> >>>

> >>> So, let's take a vote...

> >>>

> >>> Torsades?

> >>> V-Fib?

> >>> FUR?

> >>>

> >>> Alyssa Woods, NREMT-B

> >>> CPR Instructor

> >>>

> >>>

> >>> Sent from the itty bitty keyboard on my iPhone

> >>>

> >>> ------------------------------------

> >>>

> >>>

[Guest guest]

> " An EKG strip used as a pick up line has to be a first "

Come on Louis this is EMS you know that's no first!! LOL as for strip she was

talking so my vote is Poly VT Allysa quiz how would you treat it??

-Chris

Sorry for the spelling and punctuation this was typed on the tiny keyboard on my

iPhone

> An EKG strip used as a pick up line has to be a first

[Guest guest]

I'm old enough to remember some EMS firsts. You young ones just have no

imagination.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typos.

(Cell)

LNMolino@...

>> " An EKG strip used as a pick up line has to be a first "

>

>

> Come on Louis this is EMS you know that's no first!! LOL as for strip she was

talking so my vote is Poly VT Allysa quiz how would you treat it??

>

>

> -Chris

>

>

>

> Sorry for the spelling and punctuation this was typed on the tiny keyboard on

my iPhone

>

>

>

>> An EKG strip used as a pick up line has to be a first

>

>

>

[Guest guest]

Sorry I spelled your name wrong and wonder phone didn't correct it!!

-Chris

Sorry for the spelling and punctuation this was typed on the tiny keyboard on my

iPhone

>> " An EKG strip used as a pick up line has to be a first "

>

>

> Come on Louis this is EMS you know that's no first!! LOL as for strip she was

talking so my vote is Poly VT Allysa quiz how would you treat it??

>

>

> -Chris

>

>

>

> Sorry for the spelling and punctuation this was typed on the tiny keyboard on

my iPhone

>

>

>

>> An EKG strip used as a pick up line has to be a first

>

>

>

[Guest guest]

Lol, Lou That's cause we don't need it we have the Internet!!

-Chris

Sorry for the spelling and punctuation this was typed on the tiny keyboard on my

iPhone

> I'm old enough to remember some EMS firsts. You young ones just have no

imagination.

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/EMSI

> Typed by my fingers on my iPhone.

> Please excuse any typos.

> (Cell)

> LNMolino@...

>

>

>

>>> " An EKG strip used as a pick up line has to be a first "

>>

>>

>> Come on Louis this is EMS you know that's no first!! LOL as for strip she was

talking so my vote is Poly VT Allysa quiz how would you treat it??

>>

>>

>> -Chris

>>

>>

>>

>> Sorry for the spelling and punctuation this was typed on the tiny keyboard on

my iPhone

>>

>>

>>

>>> An EKG strip used as a pick up line has to be a first

>>

>>

>>

[Guest guest]

Oh, that's just fine. And she converted before we could treat, so... High flow

diesel.

And to clarify - the cute medic did say that he thought it was vtach going into

vfib. He also mentioned LQT.

I would like to note the size of the EKG.

Also, I have seven medics, a basic, and an intermediate who saw the EKG and are

agreeing with torsades, so it's not just me...

We're having a discussion as we speak...

And, I'll admit, I'm not too educated on torsades de pointes - what I know of it

is:

1. It's bad.

2. Mag sulfate.

3. It's bad.

4. Defibrillation is also an option.

5. It's rare.

6. Did I mention it's bad?

7. (Insert textbook picture which shouldn't look like real life, cause it's a

textbook...)

So any extra information you could give would be greatly appreciated.

Alyssa Woods, NREMT-B

CPR Instructor

Sent from the itty bitty keyboard on my iPhone

> Sorry I spelled your name wrong and wonder phone didn't correct it!!

>

> -Chris

>

> Sorry for the spelling and punctuation this was typed on the tiny keyboard on

my iPhone

>

>

>

> >> " An EKG strip used as a pick up line has to be a first "

> >

> >

> > Come on Louis this is EMS you know that's no first!! LOL as for strip she

was talking so my vote is Poly VT Allysa quiz how would you treat it??

> >

> >

> > -Chris

> >

> >

> >

> > Sorry for the spelling and punctuation this was typed on the tiny keyboard

on my iPhone

> >

> >

> >

> >> An EKG strip used as a pick up line has to be a first

> >

> >

> >

[Guest guest]

Oh, that's just fine. And she converted before we could treat, so... High flow

diesel.

And to clarify - the cute medic did say that he thought it was vtach going into

vfib. He also mentioned LQT.

I would like to note the size of the EKG.

Also, I have seven medics, a basic, and an intermediate who saw the EKG and are

agreeing with torsades, so it's not just me...

We're having a discussion as we speak...

And, I'll admit, I'm not too educated on torsades de pointes - what I know of it

is:

1. It's bad.

2. Mag sulfate.

3. It's bad.

4. Defibrillation is also an option.

5. It's rare.

6. Did I mention it's bad?

7. (Insert textbook picture which shouldn't look like real life, cause it's a

textbook...)

So any extra information you could give would be greatly appreciated.

Alyssa Woods, NREMT-B

CPR Instructor

Sent from the itty bitty keyboard on my iPhone

> Sorry I spelled your name wrong and wonder phone didn't correct it!!

>

> -Chris

>

> Sorry for the spelling and punctuation this was typed on the tiny keyboard on

my iPhone

>

>

>

> >> " An EKG strip used as a pick up line has to be a first "

> >

> >

> > Come on Louis this is EMS you know that's no first!! LOL as for strip she

was talking so my vote is Poly VT Allysa quiz how would you treat it??

> >

> >

> > -Chris

> >

> >

> >

> > Sorry for the spelling and punctuation this was typed on the tiny keyboard

on my iPhone

> >

> >

> >

> >> An EKG strip used as a pick up line has to be a first

> >

> >

> >

[Guest guest]

It only needs mag if it results from low mag.

Quite often it is caused by - *drumroll please* - ventricular

antiarrhythmics!

And the cute EMT is correct. Many electrophysiologists consider it an

intermediate step between VT and VF.

>

> Oh, that's just fine. And she converted before we could treat, so...

> High flow diesel.

>

> And to clarify - the cute medic did say that he thought it was vtach

> going into vfib. He also mentioned LQT.

>

> I would like to note the size of the EKG.

>

> Also, I have seven medics, a basic, and an intermediate who saw the

> EKG and are agreeing with torsades, so it's not just me...

>

> We're having a discussion as we speak...

>

> And, I'll admit, I'm not too educated on torsades de pointes - what I

> know of it is:

>

> 1. It's bad.

> 2. Mag sulfate.

> 3. It's bad.

> 4. Defibrillation is also an option.

> 5. It's rare.

> 6. Did I mention it's bad?

> 7. (Insert textbook picture which shouldn't look like real life, cause

> it's a textbook...)

>

> So any extra information you could give would be greatly appreciated.

>

> Alyssa Woods, NREMT-B

> CPR Instructor

>

>

> Sent from the itty bitty keyboard on my iPhone

>

> On Sep 2, 2010, at 8:07 PM, aggiesrwe03@...

> > wrote:

>

> > Sorry I spelled your name wrong and wonder phone didn't correct it!!

> >

> > -Chris

> >

> > Sorry for the spelling and punctuation this was typed on the tiny

> keyboard on my iPhone

> >

> > On Sep 2, 2010, at 20:02, aggiesrwe03@...

> > wrote:

> >

> > >> " An EKG strip used as a pick up line has to be a first "

> > >

> > >

> > > Come on Louis this is EMS you know that's no first!! LOL as for

> strip she was talking so my vote is Poly VT Allysa quiz how would you

> treat it??

> > >

> > >

> > > -Chris

> > >

> > >

> > >

> > > Sorry for the spelling and punctuation this was typed on the tiny

> keyboard on my iPhone

> > >

> > > On Sep 2, 2010, at 19:44, Alyssa Woods amwoods8644@...

> > wrote:

> > >

> > >> An EKG strip used as a pick up line has to be a first

> > >

> > >

> > >

[Guest guest]

So... Do you coma here often?

-Brad

Sent via BlackBerry, the office that follows you.

Re: Torsades, Or Not Torsades...

" Hey, baby... Maybe this is the caffeine talking, but you're looking a little

tachy... "

Alyssa Woods, NREMT-B

CPR Instructor

Sent from the itty bitty keyboard on my iPhone

> An EKG strip used as a pick up line has to be a first.

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/EMSI

> Typed by my fingers on my iPhone.

> Please excuse any typos.

> (Cell)

> LNMolino@...

>

>

>

> > Oh, I've had the cute EMT's number. And address. And where he's going to

school.

> >

> > He wasn't on this call; this was one I immediately turned and sent to him...

> >

> > Alyssa Woods, NREMT-B

> > CPR Instructor

> >

> >

> > Sent from the itty bitty keyboard on my iPhone

> >

> >

> >

> >> The real question is did you get the cute EMT's number.

> >>

> >> Louis N. Molino, Sr. CET

> >> FF/NREMT/FSI/EMSI

> >> Typed by my fingers on my iPhone.

> >> Please excuse any typos.

> >> (Cell)

> >> LNMolino@...

> >>

> >>

> >>

> >>> Alright... Woman comes to the doctor for shortness of breath and chest

pain.

> >>>

> >>> The chest pain got worse while she was there, and they called 911. We

arrive on scene. This is her 3-lead.

> >>>

> >>>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo.\

jpg

> >>>

> >>>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

1.jpg

> >>>

> >>>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

2.jpg

> >>>

> >>> She has a history of angina and htn.

> >>>

> >>> And, I was talking to this cute EMT, and he thinks this rhythm is V-Fib. I

believe it to be Torsades Des Pointes.

> >>>

> >>> So, let's take a vote...

> >>>

> >>> Torsades?

> >>> V-Fib?

> >>> FUR?

> >>>

> >>> Alyssa Woods, NREMT-B

> >>> CPR Instructor

> >>>

> >>>

> >>> Sent from the itty bitty keyboard on my iPhone

> >>>

> >>> ------------------------------------

> >>>

> >>>

[Guest guest]

So... Do you coma here often?

-Brad

Sent via BlackBerry, the office that follows you.

Re: Torsades, Or Not Torsades...

" Hey, baby... Maybe this is the caffeine talking, but you're looking a little

tachy... "

Alyssa Woods, NREMT-B

CPR Instructor

Sent from the itty bitty keyboard on my iPhone

> An EKG strip used as a pick up line has to be a first.

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/EMSI

> Typed by my fingers on my iPhone.

> Please excuse any typos.

> (Cell)

> LNMolino@...

>

>

>

> > Oh, I've had the cute EMT's number. And address. And where he's going to

school.

> >

> > He wasn't on this call; this was one I immediately turned and sent to him...

> >

> > Alyssa Woods, NREMT-B

> > CPR Instructor

> >

> >

> > Sent from the itty bitty keyboard on my iPhone

> >

> >

> >

> >> The real question is did you get the cute EMT's number.

> >>

> >> Louis N. Molino, Sr. CET

> >> FF/NREMT/FSI/EMSI

> >> Typed by my fingers on my iPhone.

> >> Please excuse any typos.

> >> (Cell)

> >> LNMolino@...

> >>

> >>

> >>

> >>> Alright... Woman comes to the doctor for shortness of breath and chest

pain.

> >>>

> >>> The chest pain got worse while she was there, and they called 911. We

arrive on scene. This is her 3-lead.

> >>>

> >>>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo.\

jpg

> >>>

> >>>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

1.jpg

> >>>

> >>>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

2.jpg

> >>>

> >>> She has a history of angina and htn.

> >>>

> >>> And, I was talking to this cute EMT, and he thinks this rhythm is V-Fib. I

believe it to be Torsades Des Pointes.

> >>>

> >>> So, let's take a vote...

> >>>

> >>> Torsades?

> >>> V-Fib?

> >>> FUR?

> >>>

> >>> Alyssa Woods, NREMT-B

> >>> CPR Instructor

> >>>

> >>>

> >>> Sent from the itty bitty keyboard on my iPhone

> >>>

> >>> ------------------------------------

> >>>

> >>>

[Guest guest]

Well, then, by definition it cannot be ventricular fibrillation. Patients in VF

are not conscious and do not have a pulse.

GG

Torsades, Or Not Torsades...

>

> Alright... Woman comes to the doctor for shortness of breath and chest pain.

>

> The chest pain got worse while she was there, and they called 911. We arrive

on scene. This is her 3-lead.

>

>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo.\

jpg

>

>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

1.jpg

>

>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

2.jpg

>

> She has a history of angina and htn.

>

> And, I was talking to this cute EMT, and he thinks this rhythm is V-Fib. I

believe it to be Torsades Des Pointes.

>

> So, let's take a vote...

>

> Torsades?

> V-Fib?

> FUR?

>

> Alyssa Woods, NREMT-B

> CPR Instructor

>

>

> Sent from the itty bitty keyboard on my iPhone

>

>

>

>

[Guest guest]

Well, then, by definition it cannot be ventricular fibrillation. Patients in VF

are not conscious and do not have a pulse.

GG

Torsades, Or Not Torsades...

>

> Alright... Woman comes to the doctor for shortness of breath and chest pain.

>

> The chest pain got worse while she was there, and they called 911. We arrive

on scene. This is her 3-lead.

>

>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo.\

jpg

>

>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

1.jpg

>

>

http://s842.photobucket.com/albums/zz349/amwoods8644/?action=view&current=photo-\

2.jpg

>

> She has a history of angina and htn.

>

> And, I was talking to this cute EMT, and he thinks this rhythm is V-Fib. I

believe it to be Torsades Des Pointes.

>

> So, let's take a vote...

>

> Torsades?

> V-Fib?

> FUR?

>

> Alyssa Woods, NREMT-B

> CPR Instructor

>

>

> Sent from the itty bitty keyboard on my iPhone

>

>

>

>

[Guest guest]

So... He was agreeing with me, but doing so in a way that sounded like an

argument just to be stubborn?

That sounds about right...

Alyssa Woods, NREMT-B

CPR Instructor

Sent from the itty bitty keyboard on my iPhone

> It only needs mag if it results from low mag.

>

> Quite often it is caused by - *drumroll please* - ventricular

> antiarrhythmics!

>

> And the cute EMT is correct. Many electrophysiologists consider it an

> intermediate step between VT and VF.

>

>

> >

> > Oh, that's just fine. And she converted before we could treat, so...

> > High flow diesel.

> >

> > And to clarify - the cute medic did say that he thought it was vtach

> > going into vfib. He also mentioned LQT.

> >

> > I would like to note the size of the EKG.

> >

> > Also, I have seven medics, a basic, and an intermediate who saw the

> > EKG and are agreeing with torsades, so it's not just me...

> >

> > We're having a discussion as we speak...

> >

> > And, I'll admit, I'm not too educated on torsades de pointes - what I

> > know of it is:

> >

> > 1. It's bad.

> > 2. Mag sulfate.

> > 3. It's bad.

> > 4. Defibrillation is also an option.

> > 5. It's rare.

> > 6. Did I mention it's bad?

> > 7. (Insert textbook picture which shouldn't look like real life, cause

> > it's a textbook...)

> >

> > So any extra information you could give would be greatly appreciated.

> >

> > Alyssa Woods, NREMT-B

> > CPR Instructor

> >

> >

> > Sent from the itty bitty keyboard on my iPhone

> >

> > On Sep 2, 2010, at 8:07 PM, aggiesrwe03@...

> > > wrote:

> >

> > > Sorry I spelled your name wrong and wonder phone didn't correct it!!

> > >

> > > -Chris

> > >

> > > Sorry for the spelling and punctuation this was typed on the tiny

> > keyboard on my iPhone

> > >

> > > On Sep 2, 2010, at 20:02, aggiesrwe03@...

> > > wrote:

> > >

> > > >> " An EKG strip used as a pick up line has to be a first "

> > > >

> > > >

> > > > Come on Louis this is EMS you know that's no first!! LOL as for

> > strip she was talking so my vote is Poly VT Allysa quiz how would you

> > treat it??

> > > >

> > > >

> > > > -Chris

> > > >

> > > >

> > > >

> > > > Sorry for the spelling and punctuation this was typed on the tiny

> > keyboard on my iPhone

> > > >

> > > > On Sep 2, 2010, at 19:44, Alyssa Woods amwoods8644@...

> > > wrote:

> > > >

> > > >> An EKG strip used as a pick up line has to be a first

> > > >

> > > >

> > > >

[Guest guest]

T de P is a form of polymorphic V-tach. As said, the distinguishing

characteristic is a Q-T interval that's longer than normal, typically 0.6 second

or more, or a QTc of > 45. It results from slow myocardial repolarization. It

can follow administration of some Vaughn- Class Ia sodium channel

blockers such as quinidine, procainamide, disopyramide and Class III potassium

channel blockers such as amiodarone, all of which prolong the action potential

and lengthen the effective refractory period. Many other drugs can also cause T

de P, notably antibiotics like erythromycin, clarithromycin, azitromycin, which

are commonly prescribed. Haloperidol and the phenothiazines, along with

tricyclic antidepressants can also cause it. There is a long list of other

drugs, too scary to mention.

Look for a history of taking these medications. Also some people have

congenital long Q-T syndrome.

In true torsades, there is 180º " twisting " around the isoelectric line. That

does not appear to be present in your strips. However, it is often impossible

to see the patterns in one lead. Therefore a 12-lead is preferable.

I do not think this is Torsades since the typical 180º " twist " is not present.

There is varying amplitude, but this is more typical of multifocal VT than true

T de P, in my view.

I welcome dissent and other explanations.

GG

Re: Torsades, Or Not Torsades...

Oh, that's just fine. And she converted before we could treat, so... High flow

diesel.

And to clarify - the cute medic did say that he thought it was vtach going into

vfib. He also mentioned LQT.

I would like to note the size of the EKG.

Also, I have seven medics, a basic, and an intermediate who saw the EKG and are

agreeing with torsades, so it's not just me...

We're having a discussion as we speak...

And, I'll admit, I'm not too educated on torsades de pointes - what I know of it

is:

1. It's bad.

2. Mag sulfate.

3. It's bad.

4. Defibrillation is also an option.

5. It's rare.

6. Did I mention it's bad?

7. (Insert textbook picture which shouldn't look like real life, cause it's a

textbook...)

So any extra information you could give would be greatly appreciated.

Alyssa Woods, NREMT-B

CPR Instructor

Sent from the itty bitty keyboard on my iPhone

> Sorry I spelled your name wrong and wonder phone didn't correct it!!

>

> -Chris

>

> Sorry for the spelling and punctuation this was typed on the tiny keyboard on

my iPhone

>

>

>

> >> " An EKG strip used as a pick up line has to be a first "

> >

> >

> > Come on Louis this is EMS you know that's no first!! LOL as for strip she

was talking so my vote is Poly VT Allysa quiz how would you treat it??

> >

> >

> > -Chris

> >

> >

> >

> > Sorry for the spelling and punctuation this was typed on the tiny keyboard

on my iPhone

> >

> >

> >

> >> An EKG strip used as a pick up line has to be a first

> >

> >

> >

[Guest guest]

T de P is a form of polymorphic V-tach. As said, the distinguishing

characteristic is a Q-T interval that's longer than normal, typically 0.6 second

or more, or a QTc of > 45. It results from slow myocardial repolarization. It

can follow administration of some Vaughn- Class Ia sodium channel

blockers such as quinidine, procainamide, disopyramide and Class III potassium

channel blockers such as amiodarone, all of which prolong the action potential

and lengthen the effective refractory period. Many other drugs can also cause T

de P, notably antibiotics like erythromycin, clarithromycin, azitromycin, which

are commonly prescribed. Haloperidol and the phenothiazines, along with

tricyclic antidepressants can also cause it. There is a long list of other

drugs, too scary to mention.

Look for a history of taking these medications. Also some people have

congenital long Q-T syndrome.

In true torsades, there is 180º " twisting " around the isoelectric line. That

does not appear to be present in your strips. However, it is often impossible

to see the patterns in one lead. Therefore a 12-lead is preferable.

I do not think this is Torsades since the typical 180º " twist " is not present.

There is varying amplitude, but this is more typical of multifocal VT than true

T de P, in my view.

I welcome dissent and other explanations.

GG

Re: Torsades, Or Not Torsades...

Oh, that's just fine. And she converted before we could treat, so... High flow

diesel.

And to clarify - the cute medic did say that he thought it was vtach going into

vfib. He also mentioned LQT.

I would like to note the size of the EKG.

Also, I have seven medics, a basic, and an intermediate who saw the EKG and are

agreeing with torsades, so it's not just me...

We're having a discussion as we speak...

And, I'll admit, I'm not too educated on torsades de pointes - what I know of it

is:

1. It's bad.

2. Mag sulfate.

3. It's bad.

4. Defibrillation is also an option.

5. It's rare.

6. Did I mention it's bad?

7. (Insert textbook picture which shouldn't look like real life, cause it's a

textbook...)

So any extra information you could give would be greatly appreciated.

Alyssa Woods, NREMT-B

CPR Instructor

Sent from the itty bitty keyboard on my iPhone

> Sorry I spelled your name wrong and wonder phone didn't correct it!!

>

> -Chris

>

> Sorry for the spelling and punctuation this was typed on the tiny keyboard on

my iPhone

>

>

>

> >> " An EKG strip used as a pick up line has to be a first "

> >

> >

> > Come on Louis this is EMS you know that's no first!! LOL as for strip she

was talking so my vote is Poly VT Allysa quiz how would you treat it??

> >

> >

> > -Chris

> >

> >

> >

> > Sorry for the spelling and punctuation this was typed on the tiny keyboard

on my iPhone

> >

> >

> >

> >> An EKG strip used as a pick up line has to be a first

> >

> >

> >

[Guest guest]

Well, I have one ER doc saying v-fib, the nurse beside him saying torsades, and

another doc saying v-tach... They all agree it's difficult to read, esp because

of the size.

Just to throw in yet more opinions.

And this particular service does not have 12-lead capability. Three's about as

good as it gets.

Alyssa Woods, NREMT-B

CPR Instructor

Sent from the itty bitty keyboard on my iPhone

>

> T de P is a form of polymorphic V-tach. As said, the distinguishing

characteristic is a Q-T interval that's longer than normal, typically 0.6 second

or more, or a QTc of > 45. It results from slow myocardial repolarization. It

can follow administration of some Vaughn- Class Ia sodium channel

blockers such as quinidine, procainamide, disopyramide and Class III potassium

channel blockers such as amiodarone, all of which prolong the action potential

and lengthen the effective refractory period. Many other drugs can also cause T

de P, notably antibiotics like erythromycin, clarithromycin, azitromycin, which

are commonly prescribed. Haloperidol and the phenothiazines, along with

tricyclic antidepressants can also cause it. There is a long list of other

drugs, too scary to mention.

>

> Look for a history of taking these medications. Also some people have

congenital long Q-T syndrome.

>

> In true torsades, there is 180º " twisting " around the isoelectric line. That

does not appear to be present in your strips. However, it is often impossible to

see the patterns in one lead. Therefore a 12-lead is preferable.

>

> I do not think this is Torsades since the typical 180º " twist " is not

present. There is varying amplitude, but this is more typical of multifocal VT

than true T de P, in my view.

>

> I welcome dissent and other explanations.

>

> GG

>

> Re: Torsades, Or Not Torsades...

>

> Oh, that's just fine. And she converted before we could treat, so... High flow

diesel.

>

> And to clarify - the cute medic did say that he thought it was vtach going

into vfib. He also mentioned LQT.

>

> I would like to note the size of the EKG.

>

> Also, I have seven medics, a basic, and an intermediate who saw the EKG and

are agreeing with torsades, so it's not just me...

>

> We're having a discussion as we speak...

>

> And, I'll admit, I'm not too educated on torsades de pointes - what I know of

it is:

>

> 1. It's bad.

> 2. Mag sulfate.

> 3. It's bad.

> 4. Defibrillation is also an option.

> 5. It's rare.

> 6. Did I mention it's bad?

> 7. (Insert textbook picture which shouldn't look like real life, cause it's a

textbook...)

>

> So any extra information you could give would be greatly appreciated.

>

> Alyssa Woods, NREMT-B

> CPR Instructor

>

>

> Sent from the itty bitty keyboard on my iPhone

>

>

>

> > Sorry I spelled your name wrong and wonder phone didn't correct it!!

> >

> > -Chris

> >

> > Sorry for the spelling and punctuation this was typed on the tiny keyboard

on my iPhone

> >

> >

> >

> > >> " An EKG strip used as a pick up line has to be a first "

> > >

> > >

> > > Come on Louis this is EMS you know that's no first!! LOL as for strip she

was talking so my vote is Poly VT Allysa quiz how would you treat it??

> > >

> > >

> > > -Chris

> > >

> > >

> > >

> > > Sorry for the spelling and punctuation this was typed on the tiny keyboard

on my iPhone

> > >

> > >

> > >

> > >> An EKG strip used as a pick up line has to be a first

> > >

> > >

> > >

[Guest guest]

Well, I have one ER doc saying v-fib, the nurse beside him saying torsades, and

another doc saying v-tach... They all agree it's difficult to read, esp because

of the size.

Just to throw in yet more opinions.

And this particular service does not have 12-lead capability. Three's about as

good as it gets.

Alyssa Woods, NREMT-B

CPR Instructor

Sent from the itty bitty keyboard on my iPhone

>

> T de P is a form of polymorphic V-tach. As said, the distinguishing

characteristic is a Q-T interval that's longer than normal, typically 0.6 second

or more, or a QTc of > 45. It results from slow myocardial repolarization. It

can follow administration of some Vaughn- Class Ia sodium channel

blockers such as quinidine, procainamide, disopyramide and Class III potassium

channel blockers such as amiodarone, all of which prolong the action potential

and lengthen the effective refractory period. Many other drugs can also cause T

de P, notably antibiotics like erythromycin, clarithromycin, azitromycin, which

are commonly prescribed. Haloperidol and the phenothiazines, along with

tricyclic antidepressants can also cause it. There is a long list of other

drugs, too scary to mention.

>

> Look for a history of taking these medications. Also some people have

congenital long Q-T syndrome.

>

> In true torsades, there is 180º " twisting " around the isoelectric line. That

does not appear to be present in your strips. However, it is often impossible to

see the patterns in one lead. Therefore a 12-lead is preferable.

>

> I do not think this is Torsades since the typical 180º " twist " is not

present. There is varying amplitude, but this is more typical of multifocal VT

than true T de P, in my view.

>

> I welcome dissent and other explanations.

>

> GG

>

> Re: Torsades, Or Not Torsades...

>

> Oh, that's just fine. And she converted before we could treat, so... High flow

diesel.

>

> And to clarify - the cute medic did say that he thought it was vtach going

into vfib. He also mentioned LQT.

>

> I would like to note the size of the EKG.

>

> Also, I have seven medics, a basic, and an intermediate who saw the EKG and

are agreeing with torsades, so it's not just me...

>

> We're having a discussion as we speak...

>

> And, I'll admit, I'm not too educated on torsades de pointes - what I know of

it is:

>

> 1. It's bad.

> 2. Mag sulfate.

> 3. It's bad.

> 4. Defibrillation is also an option.

> 5. It's rare.

> 6. Did I mention it's bad?

> 7. (Insert textbook picture which shouldn't look like real life, cause it's a

textbook...)

>

> So any extra information you could give would be greatly appreciated.

>

> Alyssa Woods, NREMT-B

> CPR Instructor

>

>

> Sent from the itty bitty keyboard on my iPhone

>

>

>

> > Sorry I spelled your name wrong and wonder phone didn't correct it!!

> >

> > -Chris

> >

> > Sorry for the spelling and punctuation this was typed on the tiny keyboard

on my iPhone

> >

> >

> >

> > >> " An EKG strip used as a pick up line has to be a first "

> > >

> > >

> > > Come on Louis this is EMS you know that's no first!! LOL as for strip she

was talking so my vote is Poly VT Allysa quiz how would you treat it??

> > >

> > >

> > > -Chris

> > >

> > >

> > >

> > > Sorry for the spelling and punctuation this was typed on the tiny keyboard

on my iPhone

> > >

> > >

> > >

> > >> An EKG strip used as a pick up line has to be a first

> > >

> > >

> > >