EMTV Static Cardiology Card #2

Nov 12, 2024

Static Cardiology Lecture Notes

Introduction

  • Presenter: EMTV
  • Topic: Static Cardiology cards and scenarios
  • Purpose: Mimic average time spent on each card in National Registry Static Cardiology Station

Card Scenario

  • Patient Description: 78-year-old male, profoundly bradycardic, non-responsive to verbal stimuli
  • Initial Rhythm Observation: Absence of P wave with every QRS complex indicating a possible block

Cardiac Rhythm Analysis

  • P Waves: Present but not consistently married to QRS complexes
  • QRS Complexes: Following their own intrinsic rates, indicating dissociation
  • Diagnosis: Third degree heart block

Stability Assessment

  • Criteria for Instability (CHAD):
    • Cardiac insufficiency
    • Hypotension
    • Alteration of mental status
    • Dyspnea
  • Patient Signs:
    • Weak and dizzy
    • Non-responsive to verbal stimuli (altered mental status)
    • Blood pressure: 78/50 (hypotensive)
    • Pulse: 30
    • Respirations: 8 and irregular (dyspneic)
  • Conclusion: Unstable third degree AV block

Treatment Plan

  • ACLS Algorithm: Unstable gets the cables (focus on electrical treatment)
  • Initial Steps:
    • Scene safe BSI IVO2 monitor
    • BBM patient due to inadequate ventilation (SpO2 84%)
  • Electrical Treatment:
    • Transcutaneous pacing function on monitor
    • Set pacer rate: 60-100 bpm
    • Increase milli amperage until electrical capture (pacemaker spike followed by ventricular beat)
    • Check for mechanical capture (carotid pulse)

Additional Considerations

  • Transport: Rapid transport recommended
  • Vasopressor Infusion: Consider dopamine if knowledgeable about drug doses

Conclusion

  • Encouragement: Subscribe and use static cardiology cards for practice
  • Closing: Have a good night and see you next time