mod_ DxEKG

  • [2] EKG (as interpreted by prelim ED):
    • [01] Non-remarkable EKG. No evidence of ischemia. NSR, regular rate, normal intervals, no abnormal TWI, no ST elevation/depression.
    • Rate
      • [01] normal,
      • bradycardic,
      • tachycardic,
    • [2] ST-segment morphology:
      • [01] TWaves:
        • [01] No abnormal TWI,
        • Abnormal TWI,
        • Non-specific repolarization abnormalities,
        • No ST depression, ST depression,
        • No ST elevation, ST elevation but does not meet STEMI criteria, meets STEMI criteria and cath lab activated,
    • [01] [2] Comparison to prior:
      • [01] Unchanged when compared to prior,
      • Attempted but no old EKG available for comparison,
      • __ ,
    • [01] [2] Summary to pt’s clinical condition:
      • Normal EKG – not suggestive any pathology elucidated on EKG, Non-specific repolarization abnormalities – no definitive evidence of active ischemia on EKG, Evidence on EKG concerning for active ischemia.
      • __
    • [2] Rhythm: 
      • Regularly regular: 
        • NSR,
        • Sinus tachycardia,
        • Sinus bradycardia,
      • Irregularly irregular:
        • Atrial fibrillation with normal ventricular rate,
        • Atrial fibrillation with RVR,
      • Regularly irregular:
        • tachycardic,
          • Atrial flutter with RVR,
        • bradycardic,
          • Heart block,
            • Type: __ ,
    • [2] Intervals:
      • Narrow QRS,
        • supraventricular:
          • irregular:
            • AVRT (considering pre-excitation, considering WPW, etc), 
              • Tx: Procainamide (20-50mg/min until arrhythmia suppressed, hypotension, QRS duration >50%, or max 17mg/kg. Maintenance 1-mg/min. 
              • Tx: Synchronized cardioversion.
                • Per ACLS 120-200J.
          •  regular: 
            • AVNRT (considering supraventricular tachycardia), 
              • Tx: Adenosine 6mg IV push,
                • Refractory, therefore second dose 12mg IV push 
              • Synchronized cardioverson.
                • 100 J
                • per ACLS for narrow regular 50-100J
      • Wide QRS,
        •  bradycardic:
          •  low junctional escape/ventricular origin,
        • tachycardic:
          •  regular:
            •  stable,
              •  Amiodarone 150mg IV / 10 min
                •  Refractory, repeated PRN recurrence of VT. 
                •  Maintenance 1mg/min x 6 hrs.
              •  Procainamide (20-50mg/min until arrhythmia suppressed, hypotension, QRS duration >50%, or max 17mg/kg. Maintenance 1-mg/min. 
              • synchronized cardioversion
                •  100 J (per ACLS)
            •  unstable:
              •  with pulse. Therefore Unstable Ventricular Tachycardia with Pulse. 
                •  Synchronized cardioversion (per ACLS 100J).
            •  pulseless. Therefore pulseless ventricular tachycardia. ACLS initiated: (CPR. Defibrillation 200 J Biphasic. Epi 1mg. Continuation of ACLS.)

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