Hello everyone, welcome to Static Cardiology here on EMTV. I'll be presenting you Static Cardiology cards and scenarios and a 1 minute and 30 second timer to allow you time to finish each card. This time closely mimics the average time that you should be spending on each card in the National Registry Static Cardiology Station. At the end of the card, I'll give you the answer and an explanation for the treatment. Good luck!
3, 2, 1... Thank you. So this card is a 78 year old male, profoundly bradycardic, doesn't respond to verbal stimuli.
Let's take a look at this rhythm here. So right away, because you're not seeing a P wave that's married. to every single QRS complex you should be thinking that this is a block of some kind.
Let's go ahead and take a look at our P waves here first. So there's a P wave there, a P wave there, a P wave there, a P wave there. There is more than likely a P wave hiding somewhere within this QRS complex here.
and then a P wave here and a P wave here. Your QRS complexes are here, here, and here. And these are following their own rates, their own intrinsic rates.
These are completely dissociated from each other. So this is a third degree heart block. Now let's go ahead and read the story here and find out if this is a stable or an unstable scenario.
Now your unstable criteria, of course, is Chad. cardiac insufficiency, hypotension, alteration of mental status, and dyspnea. So let's take a close look here at the story and determine whether or not this patient is stable or unstable.
So the patient is weak and dizzy. This may not necessarily be considered an unstable patient, but it should definitely cause some red flags for me as a paramedic. Felt too weak to get out of bed.
does not respond to verbal stimuli. This is definitely a CHAD criteria for instability. He is altered. Vital signs are blood pressure 78 over 50, so he's hypotensive. Pulse is 30. Respirations are 8 and irregular, so he's also dyspneic.
He meets several criterion for instability. So I would diagnose this as an unstable third degree AV block. So let's go ahead and see how we treat this. So remember, in static cardiology, your patient's condition does not change.
So this is basically reading an ACLS algorithm verbatim. This is an unstable patient. So as the old rhyme goes, unstable gets the cables.
So the treatment here is going to primarily be electrical. So your mantra is always scene safe BSI IVO2 monitor. BBM this patient because again, they were breathing at eight times a minute and it was irregular and the SpO2 is 84. percent. So this was not enough to maintain adequate ventilation. Your electrical function on your life pack, on your Zoll, on your Phyllis monitor is going to be the transcutaneous pacing function for this patient.
So the first thing we'll do is turn on the pacer, set the rate between 60 and 100 pulses per minute, and this is to mimic the normal cycle. adult atrial range or the normal sinus range for heart rate for an adult so we can get better perfusion. Go ahead and then increase the milli amperage on your device on your pacer until you see electrical capture. What this means is you have a pacemaker spike followed immediately by a ventricular beat so you have a ventricular paced rhythm that then occurs.
At this point go ahead and check for a mechanical capture aka carotid pulse to make sure that you are actually getting. what you're seeing on the monitor. At this point, I would be okay with this card as an evaluator if you said rapid transport and move on to the next thing, but if you wanted to, you could then say we could also consider beginning an infusion of a vasopressor such as dopamine.
However, if you walk yourself down into different extra protocols, you may be expected then to know the drug doses. So if you don't know this off the top of your head and you've already hit the main points of the card, go ahead and move on. So that's been that static cardiology card. If you like this content, make sure you subscribe to my channel, and feel free and use these static cardiology cards in your own playlists so you can create your own decks to practice.
Have a good rest of your night, and I will see you next time.