Guest guest Posted October 20, 2010 Report Share Posted October 20, 2010 I say treat them... provided they're all in a row, like VT. Otherwise, leave them alone. Seriously, though. There have been numerous clinical trials and studies that demonstrate that the side effects of pharmacological treatment of ventricular ectopy is worse than the ectopy itself. The AVID trial (antiarrhythmics versus implanted defibrillators) pretty conclusively demonstrated the superiority of electrical therapy over long-term antiarrhythmic use. Better to identify and treat the cause of ventricular irritability than give a selective cardiotoxin like amiodarone or one of the sodium channel blockers. I've seen medics do things like give lidocaine to someone with a bundle branch block and first degree AV block, who just happened to be throwing couplet PVCs at 12 per minute. The results were predictable - 3rd degree block - and avoidable. Worse, the medic didn't even understand why it happened, or what he'd done wrong. An experienced medic knows that the Poised Finger Technique (PFT) is just as effective as an antiarrhythmic, with absolutely no side effects. Use that instead. http://ambulancedriverfiles.com/2007/02/interesting-research/ > > To treat or not to treat? > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 21, 2010 Report Share Posted October 21, 2010 I agree, the reason why I asked this question is because I had a test question, a 48 y/o m with chest pain, br 128/72 Res. 20 pulse 88 with pvc's 20-22 min one option give lido another not to give I chose not to give now I do not know if I was right or wrong but I agree, sometime the treatment is worse than the cure. Ya gota think out there and not just be a see/do robot type medic. Lawrence ________________________________ To: texasems-l Sent: Wed, October 20, 2010 6:23:30 AM Subject: Re: pvc  I say treat them... provided they're all in a row, like VT. Otherwise, leave them alone. Seriously, though. There have been numerous clinical trials and studies that demonstrate that the side effects of pharmacological treatment of ventricular ectopy is worse than the ectopy itself. The AVID trial (antiarrhythmics versus implanted defibrillators) pretty conclusively demonstrated the superiority of electrical therapy over long-term antiarrhythmic use. Better to identify and treat the cause of ventricular irritability than give a selective cardiotoxin like amiodarone or one of the sodium channel blockers. I've seen medics do things like give lidocaine to someone with a bundle branch block and first degree AV block, who just happened to be throwing couplet PVCs at 12 per minute. The results were predictable - 3rd degree block - and avoidable. Worse, the medic didn't even understand why it happened, or what he'd done wrong. An experienced medic knows that the Poised Finger Technique (PFT) is just as effective as an antiarrhythmic, with absolutely no side effects. Use that instead. http://ambulancedriverfiles.com/2007/02/interesting-research/ > > To treat or not to treat? > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2010 Report Share Posted October 22, 2010 This is a difficult problem and not one that there's a pat answer for. This is where clinical judgment comes into play. I had an incident 25 years ago with a patient who was having an inferior MI and who started throwing PVCs enroute to the hospital. The ACLS guidelines had just changed to discourage treating PVCs, and our protocols at the time had deleted the prior criteria and basically left us with nothing to go on. Having prided myself on keeping up with changes and so forth, I chose not to treat the PVCs. But they got more numerous and he started having runs of VT. So I decided to get out the lidocaine, which was the only thing we had in those days, and I was having a debate with myself about whether to push it or not and whether or not I would be crucified by the ER doc if I did, but before I could resolve my inner debate, he fibbed. Fortunately, we had the pad system, so all I had to do was juice up the defibrillator to 200 and hit it, and he converted. Matter of fact, he cussed me out and said " if you do that again I'll kick your ass. " About that time he fibbed again and it took two shots at 300 and 360 to convert him. All this time my Intermediate was putting together the lidocaine syringe and I managed to get it pushed and he straightened out and lived to eat more chicken fried steak and smoke more cigarettes. He lived another 5 years, hardly any thanks to me. I almost had a personal Code Brown that day, What did I learn? I learned that for me, personally, I'm going to treat PVCs that are getting worse and in the context of an MI, and that's what I have done since then. But I still find the literature to be confusing and contradictory. I have no idea what the answer to the question you were asked is. I would say that it depends upon whose article you read last and your best evaluation of your patient's condition. And why ask a question like that? What do the educators among us think a question like that proves? That one can learn some algorithm or another? Gene Gandy, JD, LP, NREMT-P EMS Education and Doubt Tucson, AZ Re: pvc I say treat them... provided they're all in a row, like VT. Otherwise, leave them alone. Seriously, though. There have been numerous clinical trials and studies that demonstrate that the side effects of pharmacological treatment of ventricular ectopy is worse than the ectopy itself. The AVID trial (antiarrhythmics versus implanted defibrillators) pretty conclusively demonstrated the superiority of electrical therapy over long-term antiarrhythmic use. Better to identify and treat the cause of ventricular irritability than give a selective cardiotoxin like amiodarone or one of the sodium channel blockers. I've seen medics do things like give lidocaine to someone with a bundle branch block and first degree AV block, who just happened to be throwing couplet PVCs at 12 per minute. The results were predictable - 3rd degree block - and avoidable. Worse, the medic didn't even understand why it happened, or what he'd done wrong. An experienced medic knows that the Poised Finger Technique (PFT) is just as effective as an antiarrhythmic, with absolutely no side effects. Use that instead. http://ambulancedriverfiles.com/2007/02/interesting-research/ > > To treat or not to treat? > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2010 Report Share Posted October 22, 2010 I had a similar patient who, when I pushed the lidocaine, his entire arm went numb, and he went totally deaf for about 15 minutes. Scared the hell out of me. > > This is a difficult problem and not one that there's a pat answer for. > This is where clinical judgment comes into play. > > I had an incident 25 years ago with a patient who was having an > inferior MI and who started throwing PVCs enroute to the hospital. The > ACLS guidelines had just changed to discourage treating PVCs, and our > protocols at the time had deleted the prior criteria and basically > left us with nothing to go on. Having prided myself on keeping up with > changes and so forth, I chose not to treat the PVCs. But they got more > numerous and he started having runs of VT. So I decided to get out the > lidocaine, which was the only thing we had in those days, and I was > having a debate with myself about whether to push it or not and > whether or not I would be crucified by the ER doc if I did, but before > I could resolve my inner debate, he fibbed. > > Fortunately, we had the pad system, so all I had to do was juice up > the defibrillator to 200 and hit it, and he converted. Matter of fact, > he cussed me out and said " if you do that again I'll kick your ass. " > About that time he fibbed again and it took two shots at 300 and 360 > to convert him. All this time my Intermediate was putting together the > lidocaine syringe and I managed to get it pushed and he straightened > out and lived to eat more chicken fried steak and smoke more > cigarettes. He lived another 5 years, hardly any thanks to me. > > I almost had a personal Code Brown that day, What did I learn? I > learned that for me, personally, I'm going to treat PVCs that are > getting worse and in the context of an MI, and that's what I have done > since then. But I still find the literature to be confusing and > contradictory. > > I have no idea what the answer to the question you were asked is. I > would say that it depends upon whose article you read last and your > best evaluation of your patient's condition. And why ask a question > like that? What do the educators among us think a question like that > proves? That one can learn some algorithm or another? > > Gene Gandy, JD, LP, NREMT-P > EMS Education and Doubt > Tucson, AZ > > Re: pvc > > I say treat them... provided they're all in a row, like VT. Otherwise, > leave them alone. > > Seriously, though. There have been numerous clinical trials and studies > that demonstrate that the side effects of pharmacological treatment of > ventricular ectopy is worse than the ectopy itself. The AVID trial > (antiarrhythmics versus implanted defibrillators) pretty conclusively > demonstrated the superiority of electrical therapy over long-term > antiarrhythmic use. > > Better to identify and treat the cause of ventricular irritability than > give a selective cardiotoxin like amiodarone or one of the sodium > channel blockers. > > I've seen medics do things like give lidocaine to someone with a bundle > branch block and first degree AV block, who just happened to be throwing > couplet PVCs at 12 per minute. The results were predictable - 3rd degree > block - and avoidable. Worse, the medic didn't even understand why it > happened, or what he'd done wrong. > > An experienced medic knows that the Poised Finger Technique (PFT) is > just as effective as an antiarrhythmic, with absolutely no side effects. > Use that instead. > > http://ambulancedriverfiles.com/2007/02/interesting-research/ > > > > > > To treat or not to treat? > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2010 Report Share Posted October 22, 2010 But those were the best of the alternatives, weren't they? G Re: pvc > > I say treat them... provided they're all in a row, like VT. Otherwise, > leave them alone. > > Seriously, though. There have been numerous clinical trials and studies > that demonstrate that the side effects of pharmacological treatment of > ventricular ectopy is worse than the ectopy itself. The AVID trial > (antiarrhythmics versus implanted defibrillators) pretty conclusively > demonstrated the superiority of electrical therapy over long-term > antiarrhythmic use. > > Better to identify and treat the cause of ventricular irritability than > give a selective cardiotoxin like amiodarone or one of the sodium > channel blockers. > > I've seen medics do things like give lidocaine to someone with a bundle > branch block and first degree AV block, who just happened to be throwing > couplet PVCs at 12 per minute. The results were predictable - 3rd degree > block - and avoidable. Worse, the medic didn't even understand why it > happened, or what he'd done wrong. > > An experienced medic knows that the Poised Finger Technique (PFT) is > just as effective as an antiarrhythmic, with absolutely no side effects. > Use that instead. > > http://ambulancedriverfiles.com/2007/02/interesting-research/ > > > > > > To treat or not to treat? > > > > Quote Link to comment Share on other sites More sharing options...
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