Re: Torsades, Or Not Torsades...

[Guest guest]

I definatly do want want to take away from the pathophysiology cause it is truly

important, but I will say Alyssa that vtac whether it be torsades or not is

truly an emergency and at our level on the streets they will be treated the same

for the most part I hate that aha calls any vtac " stable " but if it is " stable "

ie they have a pulse and BP then mag is the first line for torsades and if it is

" unstable " or pulseless it it treated as vtac/vfib which is cardioversion then

medication

-Chris

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

iPhone

> 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]

I definatly do want want to take away from the pathophysiology cause it is truly

important, but I will say Alyssa that vtac whether it be torsades or not is

truly an emergency and at our level on the streets they will be treated the same

for the most part I hate that aha calls any vtac " stable " but if it is " stable "

ie they have a pulse and BP then mag is the first line for torsades and if it is

" unstable " or pulseless it it treated as vtac/vfib which is cardioversion then

medication

-Chris

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

iPhone

> 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]

If she was awake and talking it was not vfib that would be your difference

however not knowing any other info just looking at the strip I could see how it

would be seen as vfib

-Chris

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

iPhone

> 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]

Nah, you can get 9 out of 12 lead with your handy old 3-lead monitor.

Just not simultaneously.

>

> 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

>

> On Sep 2, 2010, at 10:02 PM, Wegandy wegandy@...

> > wrote:

>

> >

> > 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

> >

> > 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]

Once again, mag is effective and indicated only if low magnesium is what

caused the arrhythmia.

And with VT of all types, synchronized cardioversion is often more

effective than pushing those selective cardiotoxins that suppress the

rhythm only a little faster than they kill the patient.

Every antiarrhythmic in the prehospital arsenal receives only a Class

IIb recommendation from AHA, which is the evidence-based medicine

equivalent of " Oh what the hell, it *might* work. "

>

> I definatly do want want to take away from the pathophysiology cause

> it is truly important, but I will say Alyssa that vtac whether it be

> torsades or not is truly an emergency and at our level on the streets

> they will be treated the same for the most part I hate that aha calls

> any vtac " stable " but if it is " stable " ie they have a pulse and BP

> then mag is the first line for torsades and if it is " unstable " or

> pulseless it it treated as vtac/vfib which is cardioversion then

> medication

>

> -Chris

>

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

> keyboard on my iPhone

>

> On Sep 2, 2010, at 22:01, Alyssa Woods amwoods8644@...

> > wrote:

>

> > 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

> >

> > On Sep 2, 2010, at 9:13 PM, Grayson Grayson902@...

> > wrote:

> >

> >> 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]

Exactly. Read my article in EMS magazine a couple of years ago that explains

exactly how to do that.

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

> >

> > 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]

On Thursday, September 2, 2010 23:00, " Wegandy " wegandy@...> said:

> Exactly. Read my article in EMS magazine a couple of years ago that explains

> exactly how to do that.

Now if we can just find a way to convince people that they still have things to

learn after they pass the NR exam, they might actually start reading the

articles instead of just looking at the pictures like a Playboy magazine.

Rob

[Guest guest]

Well, I tried to get a " babe " for the pics of the electrode placement but the

magazine rejected that idea.

G

Re: Torsades, Or Not Torsades...

On Thursday, September 2, 2010 23:00, " Wegandy " wegandy@...> said:

> Exactly. Read my article in EMS magazine a couple of years ago that explains

> exactly how to do that.

Now if we can just find a way to convince people that they still have things to

learn after they pass the NR exam, they might actually start reading the

articles instead of just looking at the pictures like a Playboy magazine.

Rob

[Guest guest]

Well, I tried to get a " babe " for the pics of the electrode placement but the

magazine rejected that idea.

G

Re: Torsades, Or Not Torsades...

On Thursday, September 2, 2010 23:00, " Wegandy " wegandy@...> said:

> Exactly. Read my article in EMS magazine a couple of years ago that explains

> exactly how to do that.

Now if we can just find a way to convince people that they still have things to

learn after they pass the NR exam, they might actually start reading the

articles instead of just looking at the pictures like a Playboy magazine.

Rob

[Guest guest]

I do know how to get a 12 lead from a 3 lead. But when I'm OBSERVING, in another

state, I recognize it MIGHT not be my place to start putting extra electrodes on

someone else's patient and moving leads around, etc.

For the most part, I'm just here for the ride. The exception: if they code, I'll

pump chest.

Alyssa Woods, NREMT-B

CPR Instructor

Sent from the itty bitty keyboard on my iPhone

> Well, I tried to get a " babe " for the pics of the electrode placement but the

magazine rejected that idea.

>

> G

>

> Re: Torsades, Or Not Torsades...

>

> On Thursday, September 2, 2010 23:00, " Wegandy " wegandy@...> said:

>

> > Exactly. Read my article in EMS magazine a couple of years ago that explains

> > exactly how to do that.

>

> Now if we can just find a way to convince people that they still have things

to learn after they pass the NR exam, they might actually start reading the

articles instead of just looking at the pictures like a Playboy magazine.

>

> Rob

>

>

[Guest guest]

ROFLAO------ sooo how old is old?????? would this be dino's and

ancient dino's?????? lol-----

Dawn

[Guest guest]

ROFLAO------ sooo how old is old?????? would this be dino's and

ancient dino's?????? lol-----

Dawn

[Guest guest]

Is the prolonged QT interval specific to torsades, or does it have to do with

the syncopal episode which usually accompanies torsades?

Alyssa Woods, NREMT-B

CPR Instructor

Sent from the itty bitty keyboard on my iPhone

> ROFLAO------ sooo how old is old?????? would this be dino's and

> ancient dino's?????? lol-----

>

> Dawn

>

>