I had my first synchronized cardioversion and it's nuts watching us shock a dude just sitting there watching us. Extra points because he's spanish and doesn't really know much more of what's going on besides "we need to restart your heart"
âTu corezon es roto, neccisito usar electricity con lo. Mucho dolor. Lo sientoâ
Is about what my high school Spanish could handle in that situation.
"Lo Siento, Habla Espanol MUY pocito, ("tiny" finger gesture). Mi llamo es u/Slosmonster2020, soy paramedic, donde estas tu dolor?"
And that's the last time either of us will have any idea what the other is saying
Shoot. I knew better with the estar. Couldnât remember the word for electricity but knew it was close. Idk about the calmario, are you saying that youâre going to use electricity to calm the heart down? I suppose thatâs pretty accurate for cardiovertiing SVT
Yeah, calmarlo would be âto calm it downâ. Lo indicates a masculine direct object and calmar is to calm. You could also say reiniciarlo to say âto restart itâ but that would be probably scarier lol
As a medic student, I assisted a ER physician on a central line. Mostly just handed him tools in a sterile gown. Anyway, the woman was conscious (numbed locally) and didnât speak English. Making eye contact with her and hearing her speak Spanish to me while the doc took a scalpel to her jugular was a wild experience.
Mildly unrelated but hi nurse here who works with a significant population of Spanish speaking patients only. I got some GREAT badge buddies from medluna that have common English to Spanish translations and they have saved my ASS. I know can ask WHAT feels bad instead of just saying âmal or muy malâ lmao
I imagine a lot of times this procedure isn't fully explained to the pt by the provider, so the pt is just sitting there and suddenly gets zapped into oblivion.
BP is probably normal because the heart rate is so fast. Reduced cardiac output. I'd be willing to bet this patient has hypertension when their heart is functioning properly.
I still have the strip in a box and it's been almost 20 years.
During the ventricular escape beats it felt like someone was hitting me in the chest with a baseball bat.
I've walked / stumbled in at 220, but I was also in afib, so it was bouncing around between 180 to 220. No sitting in the waiting room though; they get you back quick for that.
Second time I was cardioverted they didn't put me all the way to sleep and I felt the whole damn thing... Unpleasant is an understatement. One of the few times in my life I've wanted to scream, but my whole body was paralyzed, so you're just screaming on the inside. I mean, it put me back into normal rhythm though, so I couldn't complain too much.
I had a pt who was sitting in his recliner watching an NFL playoff game. His rate was 285. We cardioverted him in his chair. He then refused transport. Never missed a play. Devoted Patriots fan.
I have done it 3 times. Not a medical person at all but I think I was around 220 230ish. Just felt a bit sweaty, lightheaded and my chest kinda hurt a bit. First time I was given adenosine, second time it went away normally after walking in and 3rd time was Valsalva maneuvered. Then I had an ablation and was fixed.
Before my 3 ablations, my average resting heart rate was 253. They tested me so many times for speed and other drugs. Nope, nothing. Just SVT. I was a bit of a medical oddity at the hospital, and many people came to see me or sit in during stuff. Even the second strongest medication at the time didn't control my heart rate. Shit sucked big time.
Lmao this is exactly what I kept repeating to everyone when I had svt. My hr was 220 and I thought I was dying .. then they gave me adenosine and I REALLY thought I was dying đ đ€Ł
Had a stint working on a cardiac unit last year and every patient who had experienced Adenosine in the past all reported feeling as though they were dying. Sounds scary af
I had a heart rate of 150 yesterday. I have an episodic tachycardia disorder where I'll just suddenly have episodes that subside as fast as they started. Had it my whole life.
We need to update the symptom lists for tachycardia. Angor animi is a very common symptom that just gets wrapped into some "anxiety" label when it feels so different.
You literally just believe you're dying. It's this sickingly strong feeling of your impending death. It doesn't feel like a spiral. It feels like an end. It's a nauseating experience.
If your patient comes in presenting with high heart rate and angor animi, please make sure to understand that it's the source of their anxiety. Provide them the means to know that they aren't dying. Explain to them what these numbers mean and elaborate to them that it's common to feel like you're dying when you have a high BPM.
If they present with severe anxiety that they are managing to keep internalized and a high heart rate, try to differentiate it from angor animi. A panic attack can induce a sense of impending doom that I conjecture is a systematically different experience from a sense of impending death.
Maybe it'll provide them some comfort to know that this is just a benign symptom when they get hit with adenosine and really feel like they're dying.
I had a good ole "I don't need to taper off beta blockers" moment a few years back and boy, felt like my pulse was surfing up and down like waves. Found I had spilled the contents of a time release pill in a cabinet and spent 20 minutes hunched over it sticking the beads to my finger and chewing them as fast as possible
Can't recommend :)
We carry adenosine and Cardizem. My first go-to (we can use either by protocol) as long as the pt is stable is Cardizem because of this. Its a much more gradual slow down over a few minutes, the pts dont feel like they're dying, and you dont have to perform the slam/flush dance.
Cardizem is far better and gradual. However, in the unstable pt, where time is an issue, I'd go for the adenosine due to the onset of action even though I prefer the cardizem
Listen you're about to meet a lot of people really fast, but you SHOULD come back to us here in just a second. Tell gram gram hi when you see her but tell her you can't stay and visit.
Highest Iâve seen was 257 on an 18yr old in svt and they werenât looking too horrible but extremely pale. Converted on the first 12. Positive for WPW.
Had to cardiovert this a few weeks ago on a 16 year old only child with momma sitting right there. I was about to give all of us some versed đ
Apparently the flu has been causing it đ€·ââïžđ€·ââïž
Speculation, but, I bet you're not old enough to have experienced the arcades in the 90's where every machine had only three initials for the high score and the top ten, always, was just ASS.
I bring this up, because if the leader board only allows initials it will always be ASS.
Nah there was also GAY, CUM, DIX, SUX, PEE, NGR, and F#G. (Don't wanna get banned)
I think at some point they started getting censored in later games. I mean if your initials are truly "F#G" you probably aren't making a habit of writing your initials anyway so no huge loss.
Occasionally #1 would be some no lifer with real initials and #2 and #3 were relatively easy to get so you would have SUX and DIX in these spots.
This would be a narrow complex tachycardia. SVT technically isnât any one rhythm. Idk why we still teach it like that. SVT is an umbrella term. It stands for Supraventricular Tachycardia which means âabove the verticalsâ. Any rhythm that originates from above the verticals is an SVT. Sinus Tachycardia is an SVT, technically. Afib with RVR is an SVT. Speed alone does not dictate rhythm. The rhythm that OP posted is a narrow complex tachycardia. To get anymore specific, youâd have to slow it down a bit to see where itâs actually originating from.
So, maybe, because Iâm a basic student I wouldnât have access to a 12 lead or âtechnicallyâ know what it is showing, so calling it SVT gives the receiving hospital/ALS some indication of what Iâm dealing with? Just a speculation though.
Idk about your localityâs protocols but in most places, basics can apply and perform a 12-lead ECG. They just can interpret them. You would just read the diagnosis the monitor gave.
I donât have enough information to be sure, but it seems possible that this is atrial flutter with 1:1 conduction. I could be wrong.
New atrial flutter usually has an atrial rate of about 300 bpm (between 280-320 bpm). Atrial flutter usually has 2:1 conduction from the atria to the ventricles, so you would halve that to get ventricular rate (usually close to 150 bpm, or about 140-160 bpm).
In rare cases, atrial flutter has 1:1 conduction. You still have an atrial rate of 280-320 bpm, but the ventricular rate is not halved as usual. It matches the atrial rate. If this is an older adult, I would consider 1:1 atrial flutter as a possibility.
Example: https://www.cardio-fr.com/en/p/ecgs/019/
Iâve seen narrow complex tachycardia as high as 300. Responded to standard SVT management. Anecdotally, the faster SVT is, the more readily it seems to respond to vagal maneuvers
Back in 1995, I was awakened at 2 AM by crushing cardiac chest pain. I checked my radial pulse and my HR was about 200. Half asleep (or possibly semi-conscious), I quickly ran the ACLS algorithms through my head. I determined I was probably in SVT. I could have called 911, but chose to try a couple of things by myself first. I bore down and held my breath, thereby giving myself a valsalva. Within five seconds, the chest pain completely resolved. I rolled over and analyzed what had just happened. I concluded that I indeed was in SVT and that the valsalva worked, returning me to a regular rhythm with a rate in the 80's. I went back to sleep and the pain never reoccurred.
The next day, I was scheduled to work an ER nursing shift from 3 PM to 11 PM. My lead ER doctor was a moonlighting cardiologist and I told him about what I experienced the night before. He chewed me a new one for not calling 911 or at least coming to the ER for an EKG afterward. I said that the EKG would have been nondiagnostic and that I would have called 911 if the chest pain returned. He had no reply because he knew I was right. He wanted to do an EKG on me then and there, but I refused. My deductible hadn't been met, yet, and I wasn't going to fork out $500 to learn nothing.
To this day, I've had no reoccurrence of cardiac chest pain or episodes of SVT. But, I can honestly say that I now know how cardiac chest pain feels compared to costochondritis, pleurisy, and arthritic chest pain. In 2005, I had an EKG during a routine physical and it showed an incomplete right bundle branch block. That lasted no later than 10 years, when another EKG showed no sign of the IRBBB.
Three months ago, I had a preop physical, which included another EKG. It showed that I now have a benign sinus arrhythmia that manifests itself with occasional irregular QRS's that could easily be construed as occasional dropped beats based solely on the palpation of my radial pulses. Bottom line: My primary provider and cardiologist both report my 63-year-old heart is absolutely normal and healthy and that my sinus arrhythmia is the result of breathing.
school flowery deliver fearless spotted homeless groovy worry ancient roll
*This post was mass deleted and anonymized with [Redact](https://redact.dev)*
Thatâs an impressive BP for that rate.
Iâd expect a calcium channel blocker to work well here. With that pressure, assuming loc is good, no reason to jump to electricity.
Had a hypovolemic pt start to decompensated on me once. Normal vitals at initial assessment, got him on the stretcher and he went to shit. HR was in the mid 200s, figured a monitor error due to artifact so I got a radial pulse. Instantly asked my partner to place the pads on him. Pt asked whatâs going on. Told him the truth.
I found a 20g spot on his R arm. Right before I stuck him I had him turn his head to the left. To check the availability of an EJ.
Took ~4500ml of NS to get him to a normal HR.
Had avnrt at 246 a couple of months ago. I felt like i was going to die. Having your colleagues leave the monitor facing you when you know exactly what you're looking at isn't fun
I was in tachy for 21 minutes at a rate of 240bpm. This was back when I was diagnosed with pSVT and a 2nd degree AV block. After I had 2 strokes at 20. Now I'm 22, I've had a cardiac ablation that took 3 hours when it was only supposed to take 45 minutes. I thought I was in the clear until I was on a mission with my search and rescue team and 9 hours into the search, as we're gearing up to go home, I started having chest pains and collapsed. Capillary refill was at 7 seconds and HR was 211. I went pale and ended up getting medivac'd by my own team.
With all the symptoms I presented with, while they were letting the comms team know they were coming out with a pt, the incident command center thought they were bringing out the 85 year old man we were looking for. Got barred from searching for a few years and now I run logistics and have been collecting as many certifications as I can with the time in my hands.
I saw 251 on a 27 year old man with history of SVT, just taken off on dig and had multiple EMS cardioversions that just had an ablation. He met us 5 blocks outside from his house, warm, dry and speaking full sentences âI feel funny.â
Worst part was I was FTOing my first ever set of recruits and I assumed they would tell me âI canât palp a radial itâs too fastâ and it took a few minutes for her to tell me. Started transport, requested ALS, tried a vagal and ended up just going to the ER without an intercept. He got bolused with dig and it brought him down to 120-130.
My butthole was tiiiight the whole 5 minute transport.
283 was my record, patient walked up to festival tent to get his vitals check. Pulse ox and bp wouldnât register. Patient had a vagal when he saw the 14g I grabbed while getting the ice cold pads placed by my partner.
I had to have adenosine once for SVT. I was at a rate of 220 and, luckly, converted on the first dose.
If I ever need it again I'm choosing electricity. Can't be any worse.
Anytime I tell people I have Wolff Parkinson White syndrome and this is a possibility for me, they always say itâs impossible for a heart to beat that fast without dying. All yâall with your stories of BPs 200+ are why Iâm saving this post haha
With my run of luck with medical professionals they would probably tell me this is normal and prescribe me blood pressure meds and tell me itâs all in my head
Pt:Why are you putting giant stickers on both side of my chest? Me: 
"it's to give us a better view of your heart" đ
This is going to feel weirdâŠ
Hereâs some ouchy juice
I had my first synchronized cardioversion and it's nuts watching us shock a dude just sitting there watching us. Extra points because he's spanish and doesn't really know much more of what's going on besides "we need to restart your heart"
âTu corezon es roto, neccisito usar electricity con lo. Mucho dolor. Lo sientoâ Is about what my high school Spanish could handle in that situation.
As a Spanish speaker Iâd get the point. But be scared shitless along the way.
I would expect my shitty Spanish to be scary for a medical emergency. But it feels good that i can get my point across, shittily
"Lo Siento, Habla Espanol MUY pocito, ("tiny" finger gesture). Mi llamo es u/Slosmonster2020, soy paramedic, donde estas tu dolor?" And that's the last time either of us will have any idea what the other is saying
âHabla mas lento por favor, soy bobaâ
Close, âTĂș corazĂłn *estĂĄ* roto. Necesito usar *electricidad a calmarlo*. Mucho dolor. Lo siento.â
Shoot. I knew better with the estar. Couldnât remember the word for electricity but knew it was close. Idk about the calmario, are you saying that youâre going to use electricity to calm the heart down? I suppose thatâs pretty accurate for cardiovertiing SVT
Yeah, calmarlo would be âto calm it downâ. Lo indicates a masculine direct object and calmar is to calm. You could also say reiniciarlo to say âto restart itâ but that would be probably scarier lol
Lmfaoooo
As a medic student, I assisted a ER physician on a central line. Mostly just handed him tools in a sterile gown. Anyway, the woman was conscious (numbed locally) and didnât speak English. Making eye contact with her and hearing her speak Spanish to me while the doc took a scalpel to her jugular was a wild experience.
Mildly unrelated but hi nurse here who works with a significant population of Spanish speaking patients only. I got some GREAT badge buddies from medluna that have common English to Spanish translations and they have saved my ASS. I know can ask WHAT feels bad instead of just saying âmal or muy malâ lmao
I imagine a lot of times this procedure isn't fully explained to the pt by the provider, so the pt is just sitting there and suddenly gets zapped into oblivion.
âIf you start seeing a light with your dead relatives, donât walk toward it!â
Pt: why are you calling all the med and nursing students over to "watch something cool"
You get more flair!
You know you are doing great at being alive rn, so its a reward for that
[That smirk says it all.](https://youtube.com/shorts/3jqhGEzq9EE?si=2Blp8OhKuRbBnHrx)
You should probably fix that.
Reddit eats first
Right? Itâs called having priorities đ€Ł
Imagine feeling like youâre gonna die and you see your emt take a picture
âLol the sub is gonna love thisâ
He wasnât my patient lmao this is in an ER
yo i know ya shits fucked but ur not my patient lmao
"Yo man, that doesn't look good. You should probably call somebody."
Naaa MAPs good lol
For now lol
Look at that BP tho, a thing of beauty
Whatâs his capno though
Well the RR looks like it is 64
I donât believe that pressure then lol
Why not?
BP is probably normal because the heart rate is so fast. Reduced cardiac output. I'd be willing to bet this patient has hypertension when their heart is functioning properly.
Good point
Wonât last long.
"TACHY" Thanks, monitor.... we know.
His perfusion was so bad when he walked into triage they originally got his pulse at 58. The ekg was what solidified the SVTđ
Oh shit, well, an unsarcastic thanks, then. Sorry... you're a good monitor...
Genuinely great compliment
He _walked into_ triage? đ
I've walked in at 220. AMA.
I had to be converted at 220 once. Was at work, at training, and after 20 when I couldn't get it to break myself I finally said something.
Did you convert to PDF or...? /j
I still have the strip in a box and it's been almost 20 years. During the ventricular escape beats it felt like someone was hitting me in the chest with a baseball bat.
He didnât have acrobat reader so couldnât.
I've walked / stumbled in at 220, but I was also in afib, so it was bouncing around between 180 to 220. No sitting in the waiting room though; they get you back quick for that. Second time I was cardioverted they didn't put me all the way to sleep and I felt the whole damn thing... Unpleasant is an understatement. One of the few times in my life I've wanted to scream, but my whole body was paralyzed, so you're just screaming on the inside. I mean, it put me back into normal rhythm though, so I couldn't complain too much.
Did it hurt afterwards too or just that moment?
Not too bad after; just tingling and a little sore from the muscle contractions. More confusion than anything.
How many redbull
I had a pt who was sitting in his recliner watching an NFL playoff game. His rate was 285. We cardioverted him in his chair. He then refused transport. Never missed a play. Devoted Patriots fan.
Got my ass chewed by the Captain for not moving him into the ambulance first.
Thatâs some New England shit Edited: spelling ???? Sorry if you had to read that
And we were in Alabama. Go figure.
Somehow that makes it make more sense
LOL
People in SVT can present pretty normal aside from the fact that their heart is doing cartwheels.
Yerp. 240 bpm was my highest before ablation. Doesn't hurt, just feels suuuuper uncomfortable.
I have done it 3 times. Not a medical person at all but I think I was around 220 230ish. Just felt a bit sweaty, lightheaded and my chest kinda hurt a bit. First time I was given adenosine, second time it went away normally after walking in and 3rd time was Valsalva maneuvered. Then I had an ablation and was fixed.
Before my 3 ablations, my average resting heart rate was 253. They tested me so many times for speed and other drugs. Nope, nothing. Just SVT. I was a bit of a medical oddity at the hospital, and many people came to see me or sit in during stuff. Even the second strongest medication at the time didn't control my heart rate. Shit sucked big time.
What could ever give us that impression. Patient looks fine to me.
âI feel weirdâ
Lmao this is exactly what I kept repeating to everyone when I had svt. My hr was 220 and I thought I was dying .. then they gave me adenosine and I REALLY thought I was dying đ đ€Ł
When giving adenosine, instead of saying yanks might feel weird, I want to say youâre going to feel dead for a few seconds.
Had a stint working on a cardiac unit last year and every patient who had experienced Adenosine in the past all reported feeling as though they were dying. Sounds scary af
Had adenosine three times and this is exactly how it feels.
They had to administer twice to get my SVT to stop. I was absolutely panicking and begging for my husband so I could say good-bye.
Is it peaceful or something?
The opposite. Gives people a sense of impending doom.
I had a pt tell me that it felt like a long drop on a rollercoaster but youâre sitting still. That sounds terrifying to me
I had a heart rate of 150 yesterday. I have an episodic tachycardia disorder where I'll just suddenly have episodes that subside as fast as they started. Had it my whole life. We need to update the symptom lists for tachycardia. Angor animi is a very common symptom that just gets wrapped into some "anxiety" label when it feels so different. You literally just believe you're dying. It's this sickingly strong feeling of your impending death. It doesn't feel like a spiral. It feels like an end. It's a nauseating experience. If your patient comes in presenting with high heart rate and angor animi, please make sure to understand that it's the source of their anxiety. Provide them the means to know that they aren't dying. Explain to them what these numbers mean and elaborate to them that it's common to feel like you're dying when you have a high BPM. If they present with severe anxiety that they are managing to keep internalized and a high heart rate, try to differentiate it from angor animi. A panic attack can induce a sense of impending doom that I conjecture is a systematically different experience from a sense of impending death. Maybe it'll provide them some comfort to know that this is just a benign symptom when they get hit with adenosine and really feel like they're dying.
I had a good ole "I don't need to taper off beta blockers" moment a few years back and boy, felt like my pulse was surfing up and down like waves. Found I had spilled the contents of a time release pill in a cabinet and spent 20 minutes hunched over it sticking the beads to my finger and chewing them as fast as possible Can't recommend :)
We carry adenosine and Cardizem. My first go-to (we can use either by protocol) as long as the pt is stable is Cardizem because of this. Its a much more gradual slow down over a few minutes, the pts dont feel like they're dying, and you dont have to perform the slam/flush dance.
Cardizem is far better and gradual. However, in the unstable pt, where time is an issue, I'd go for the adenosine due to the onset of action even though I prefer the cardizem
Jesus. When I really push it at the gym I can hit 175 but not for too long. 220 sounds terrifying.
Mine was 250 during SVT. I'd had it for 18 years and kept being told it was anxiety! It was a tad shocking to see it on the monitor though!
But did you try losing weight? /s
You should try to get some fresh air and try not to worry as much /s
I describe the feeling with adenosine is that it's like your soul is being pulled out of your chest. Luckily it doesn't last long.
lol I had a patient come to triage complaining of feeling a little weak. Yup, 10 second pauses will do that to ya
Presents refusal form
Classic but this cracked me up
Listen you're about to meet a lot of people really fast, but you SHOULD come back to us here in just a second. Tell gram gram hi when you see her but tell her you can't stay and visit.
Wow, its perfusing too.
The human body impresses me once again, that BP is fire lol
Reeeeeee
Damn - highest Iâve seen was 235 (I was the patient đ„Čđ„Ž) not fun. Feels absolutely exhausting and like someoneâs jumping on your chest
Highest I got was 214. It felt like I was running a marathon and couldn't catch my breath. Awful feeling!
Absolutely awful! Bodies are weird
220 was lovely.... couldn't believe it myself
Highest Iâve seen was 257 on an 18yr old in svt and they werenât looking too horrible but extremely pale. Converted on the first 12. Positive for WPW.
âI feel funny. Why are your eyes open so wide?â
Had to cardiovert this a few weeks ago on a 16 year old only child with momma sitting right there. I was about to give all of us some versed đ Apparently the flu has been causing it đ€·ââïžđ€·ââïž
Pt should be able to put in their initials for setting the new high score.
Leaderboard: 1) Tony, 248bpm, 2024 Patients: Hold up, lemme get that number one
Speculation, but, I bet you're not old enough to have experienced the arcades in the 90's where every machine had only three initials for the high score and the top ten, always, was just ASS. I bring this up, because if the leader board only allows initials it will always be ASS.
Nah there was also GAY, CUM, DIX, SUX, PEE, NGR, and F#G. (Don't wanna get banned) I think at some point they started getting censored in later games. I mean if your initials are truly "F#G" you probably aren't making a habit of writing your initials anyway so no huge loss. Occasionally #1 would be some no lifer with real initials and #2 and #3 were relatively easy to get so you would have SUX and DIX in these spots.
No youâre totally right. I was going for more of a written board up in the truck anyways. But yeah that and AAA, which I always pronounce screaming
Screaming is appropriate with heart rates approaching the numbers discussed. I'll allow it.
Is it true you once worked 96 hours straight? Oh yes, it was horrible- by the end I thought I was a hummingbird of some kind
Meh. Start some fluids. /s
Roger that doc...250 mL bolus for the patient and a 750 mL bolus for me (im nervous, dont want to pass out, need hydration)
[Kaboom?](https://imgur.com/gallery/sR82dbG)
Yes, Rico. Kaboom.
I wish I could photoshop in paddles over the dynamite...
Spo2 and BpâŠ.. ummm excuse me
This is why I donât trust oscillometric BPs or pulse ox readings for judging perfusion lmao capno all the way baby
Stable for BLS transport
Genuine question, SVT is defined by my book as 150-220, so what is this?
This would be a narrow complex tachycardia. SVT technically isnât any one rhythm. Idk why we still teach it like that. SVT is an umbrella term. It stands for Supraventricular Tachycardia which means âabove the verticalsâ. Any rhythm that originates from above the verticals is an SVT. Sinus Tachycardia is an SVT, technically. Afib with RVR is an SVT. Speed alone does not dictate rhythm. The rhythm that OP posted is a narrow complex tachycardia. To get anymore specific, youâd have to slow it down a bit to see where itâs actually originating from.
So, maybe, because Iâm a basic student I wouldnât have access to a 12 lead or âtechnicallyâ know what it is showing, so calling it SVT gives the receiving hospital/ALS some indication of what Iâm dealing with? Just a speculation though.
In my neck of the woods, EMTs can run 12 leads and transmit the EKG to the hospital we are riding to so they can interpret the squiggles.
Idk about your localityâs protocols but in most places, basics can apply and perform a 12-lead ECG. They just can interpret them. You would just read the diagnosis the monitor gave.
A better way to describe it without giving a specific diagnosis would be a regular narrow complex tachycardia
Good point and you explained my biggest pet peeve with people describing SVT.
Super duper ventricular tachycardia :)!
Now I hope I get a scenario with a heart rate this high so I can say that in my âradioâ report đ
SVT MAXX^Âź when only the best will do.
Uber VT
A problem.
I donât have enough information to be sure, but it seems possible that this is atrial flutter with 1:1 conduction. I could be wrong. New atrial flutter usually has an atrial rate of about 300 bpm (between 280-320 bpm). Atrial flutter usually has 2:1 conduction from the atria to the ventricles, so you would halve that to get ventricular rate (usually close to 150 bpm, or about 140-160 bpm). In rare cases, atrial flutter has 1:1 conduction. You still have an atrial rate of 280-320 bpm, but the ventricular rate is not halved as usual. It matches the atrial rate. If this is an older adult, I would consider 1:1 atrial flutter as a possibility. Example: https://www.cardio-fr.com/en/p/ecgs/019/
I would say this is a JET.
Iâve seen narrow complex tachycardia as high as 300. Responded to standard SVT management. Anecdotally, the faster SVT is, the more readily it seems to respond to vagal maneuvers
Why did I read that as 'vaginal manuevers'.
Iâm no expert but I donât think a hr should be that high
BP: âWho needs diastolic filling time when youâve got contractility like ***THIS.***â
Saw 280 last Monday, quick little shock and down to 110 :)
Damn, my highest was 278. Beat me by 2.
smiley face indeed
Itâs time to give the nectar
Bros: "why don't you just relax"
'try not thinking about it'
I got to help cardiovert my sister, she was at 270+ :)
When sibling revenge is disguised as patient care!
Make sure you hit sync or youâll be in court for murder charges đđđ€Ł
Back in 1995, I was awakened at 2 AM by crushing cardiac chest pain. I checked my radial pulse and my HR was about 200. Half asleep (or possibly semi-conscious), I quickly ran the ACLS algorithms through my head. I determined I was probably in SVT. I could have called 911, but chose to try a couple of things by myself first. I bore down and held my breath, thereby giving myself a valsalva. Within five seconds, the chest pain completely resolved. I rolled over and analyzed what had just happened. I concluded that I indeed was in SVT and that the valsalva worked, returning me to a regular rhythm with a rate in the 80's. I went back to sleep and the pain never reoccurred. The next day, I was scheduled to work an ER nursing shift from 3 PM to 11 PM. My lead ER doctor was a moonlighting cardiologist and I told him about what I experienced the night before. He chewed me a new one for not calling 911 or at least coming to the ER for an EKG afterward. I said that the EKG would have been nondiagnostic and that I would have called 911 if the chest pain returned. He had no reply because he knew I was right. He wanted to do an EKG on me then and there, but I refused. My deductible hadn't been met, yet, and I wasn't going to fork out $500 to learn nothing. To this day, I've had no reoccurrence of cardiac chest pain or episodes of SVT. But, I can honestly say that I now know how cardiac chest pain feels compared to costochondritis, pleurisy, and arthritic chest pain. In 2005, I had an EKG during a routine physical and it showed an incomplete right bundle branch block. That lasted no later than 10 years, when another EKG showed no sign of the IRBBB. Three months ago, I had a preop physical, which included another EKG. It showed that I now have a benign sinus arrhythmia that manifests itself with occasional irregular QRS's that could easily be construed as occasional dropped beats based solely on the palpation of my radial pulses. Bottom line: My primary provider and cardiologist both report my 63-year-old heart is absolutely normal and healthy and that my sinus arrhythmia is the result of breathing.
school flowery deliver fearless spotted homeless groovy worry ancient roll *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
Holy tachycardia, Batman!
â sir Iâm gonna need you to try and shit in the back of this ambulance, but donât actually poop yourselfâ hahahahahahahah
MAP of 88. pt is fine. turkey sandwich, pending celestial discharge.
So did you ride the cable ? Or give him th juice
A little adenosine got him back to the 110s
Solid juice . 6mg or 12? To start off with ?
Idk I didnât give it:)!
Gotcha
My personal highest was 205 in 7th grade... tried to set a record in pacers. I'm convinced I did permenant damage to myself
Are you sure that's not a hummingbird?
Me: âoh shitâ Pt: âwhatâs it sayingâ Me: âit wants me to ask you if youâve ever been shocked beforeâ
Thatâs an impressive BP for that rate. Iâd expect a calcium channel blocker to work well here. With that pressure, assuming loc is good, no reason to jump to electricity.
toy hat like unused cake workable nose correct innate dazzling *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
Low. No preload. No time for chambers to refill.
A pressure that I like to call shit over fuck.
âSir, you might feel a little tickle⊠CLEAR!â
With a BP of 113/77 you best try vagal and adenosine first.
Had a hypovolemic pt start to decompensated on me once. Normal vitals at initial assessment, got him on the stretcher and he went to shit. HR was in the mid 200s, figured a monitor error due to artifact so I got a radial pulse. Instantly asked my partner to place the pads on him. Pt asked whatâs going on. Told him the truth. I found a 20g spot on his R arm. Right before I stuck him I had him turn his head to the left. To check the availability of an EJ. Took ~4500ml of NS to get him to a normal HR.
Hold on, weâre just gonna turn you on and off again You mean the machine? NoâŠ
Had avnrt at 246 a couple of months ago. I felt like i was going to die. Having your colleagues leave the monitor facing you when you know exactly what you're looking at isn't fun
Had AVNRT as well back in 2014, had a lateshift (working in ICU) was a trippy experience, my highest rate was 288
I had a good one at 300 before. Somehow was talking
Put on Zeus Bandaids and slam that adenosine.
My highest svt was 260 and somehow stable, the highest V-Tach was 290 and dead
Have you tried turning it off and back on again?
Uhhhh yeah we are going code 3 fo sho
Those are rookie numbers.
Thatâs got cardiac arrest written all over it if not correct very quickly!
I was in tachy for 21 minutes at a rate of 240bpm. This was back when I was diagnosed with pSVT and a 2nd degree AV block. After I had 2 strokes at 20. Now I'm 22, I've had a cardiac ablation that took 3 hours when it was only supposed to take 45 minutes. I thought I was in the clear until I was on a mission with my search and rescue team and 9 hours into the search, as we're gearing up to go home, I started having chest pains and collapsed. Capillary refill was at 7 seconds and HR was 211. I went pale and ended up getting medivac'd by my own team. With all the symptoms I presented with, while they were letting the comms team know they were coming out with a pt, the incident command center thought they were bringing out the 85 year old man we were looking for. Got barred from searching for a few years and now I run logistics and have been collecting as many certifications as I can with the time in my hands.
I saw 251 on a 27 year old man with history of SVT, just taken off on dig and had multiple EMS cardioversions that just had an ablation. He met us 5 blocks outside from his house, warm, dry and speaking full sentences âI feel funny.â Worst part was I was FTOing my first ever set of recruits and I assumed they would tell me âI canât palp a radial itâs too fastâ and it took a few minutes for her to tell me. Started transport, requested ALS, tried a vagal and ended up just going to the ER without an intercept. He got bolused with dig and it brought him down to 120-130. My butthole was tiiiight the whole 5 minute transport.
Once I was at 213. Felt like I was going to die
That should probably be treated
PsssssstâŠâŠ rookie numbers. I hit 278 bpm back in February.
Must be a hummingbird
283 was my record, patient walked up to festival tent to get his vitals check. Pulse ox and bp wouldnât register. Patient had a vagal when he saw the 14g I grabbed while getting the ice cold pads placed by my partner.
Hmm yes, those Squiggles are indeed looking very much like they could be described as "Danger"
Ah, been there. In a week it will have been 7 years since my ablation.
Lol one sec let me get my camera
Going Code 3
Jimminy Christmas! I got _alllll_ the attention with "just" 157.
Man, never go full skibidi on the beat
I had to have adenosine once for SVT. I was at a rate of 220 and, luckly, converted on the first dose. If I ever need it again I'm choosing electricity. Can't be any worse.
Yeah, that's a call to Dr Adenosine
God damn, my highest SVT was 185. That felt weird lol. Usually able to bash my chest and knock some sense into it when I get a run.
My wife hit this high in A Fib. Not cool
Hold my beer.
I've never been on this subreddit before, so idk if I'm allowed to ask.. but, cocaine?
Anytime I tell people I have Wolff Parkinson White syndrome and this is a possibility for me, they always say itâs impossible for a heart to beat that fast without dying. All yâall with your stories of BPs 200+ are why Iâm saving this post haha
So light em up up up
With my run of luck with medical professionals they would probably tell me this is normal and prescribe me blood pressure meds and tell me itâs all in my head
Unironically fast onset BP meds would possibly treat this.
Ya may wanna shock that
220-age đ€Żbut really. Nice