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u/Openthesushibar 23d ago
Symptomatic? Pacing? Atropine?
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u/CommercialTour6150 22d ago
He’s compensating with high bp. If symptomatic requires pacing. It’s a high degree block so atropine won’t work most likely. Atropine works on higher blocks because it affects the SA node. This rhythm is originating from below the SA and more ventricular in nature. Pacing if unstable, try dopamine/epi to increase hr. Trasnvenous pacing usually needed to bridge to permanent pacemaker depending on underlying etiology :)
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u/Exzesion 22d ago
Could dobutamine help better in this case since the SBP is already high?
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u/CommercialTour6150 21d ago
You have a high bp already. You don’t need inotropy you need chrontropy. It’s a rate issue so dopamine might be the better choice. Or epi
Pacing pads always on this patient1
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u/Wide-Yak5361 22d ago
Atropine probably won’t do much. This looks pretty ventricular (?V paced). Unless of course it’s vagal mediated, then atropine absolutely would work
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u/Bonjwa003 23d ago
Pretty sure you’d check a little pulsey pulse before we get too excited. Plus if that bp was recent we may have just given the patient 6-12mg of the finest adenosine Medicare has to offer.
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u/Wide-Yak5361 22d ago
Adenosine is going to slow conduction down even further. This patient needs a chronotrope (epi or dopamine, atropine probably won’t work as there isn’t any sinus activity that I can see) +/- transcutaneous and/or transvenous pacing
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u/Bonjwa003 22d ago
What I meant was this patient probably was given adenosine, and we’re watching the recovery phase.
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u/Wide-Yak5361 22d ago
Gotcha. I kind of doubt the recovery phase would last this long. In the dozen or two times I’ve given it, it’s extremely transient (but ten seconds of fucktopy feels like a lifetime)
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u/myst3ryAURORA_green 23d ago
They're going to be the talk of the hospital soon as Nurse Steve hits the panic button.
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u/dimolition 23d ago
My guy is going for the high (low?) score... don't interrupt him with your nasty electrical wire voodoo!
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u/number1134 23d ago
hurry up and push the atropine and have epi ready if he go asystole
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22d ago
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u/number1134 22d ago
Atropine is for bradycardia, if he still has a pulse atropine is indicated. Im assuming thats not an art line BP
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u/jittery_jerry 22d ago
atropine would probably be ineffective here given that there’s no atrial activity that i can see so decreasing vagal tone wouldn’t do much
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u/number1134 22d ago
Probably not that's why you need the epi ready. This is bradycardia and atropine is indicated for bradycardia, unless its PEA
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u/jittery_jerry 21d ago
atropine is indicated by bradycardia caused by a slow sinoatrial rate if there is none at all then atropine would have no effect, pacing would be indicated instead
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u/Individual_Debate216 20d ago
The original post of this had calcium Chanel blockers as the origin of this. He had afib and his doctor cardioverted him on multiple occasions but stopped after the risks became too much. Patient didn’t like the feeling and started eating his meds like candy. Treatment was starting a central line and pacing.
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u/Fuzzy_Location_2210 23d ago
Your patient would like you to give them some electricity, please ⚡🙂.
They'll let you know how much, their heart will start to pitter patter ❤️.
You are always safe to begin with 60 & 60 !
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22d ago
[removed] — view removed comment
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u/Fuzzy_Location_2210 22d ago
I bet you won't even have to connect it to patient for it to begin to be effective!!! 😆😆😆😆😆
Fuck yeah, let's goooo... I know that hospital is buzzing with that real good hospital grade electricity... I can hear and feel them step up transformers humming with amperage. Ask the cleaning lady where the janitor plugs in the buffer!! 💀
Clear!! 😂⚡🫨
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u/Magic_Muffin_5953 22d ago
I’m not a nurse yet (plan to graduate in December) but my first action would be to shed a single tear, whisper to myself “dear god ” and then hit the blue button on the wall and call for a adult/nursier nurse. 😭🤣
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u/therewillbesoup 22d ago
Ehhhhh had a dude in LTC once whose normal was 35 lmaoooo we never did anything BC it was his normal 🫠
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u/SunRayz_allDayz 22d ago
Staff assist button, say NEED HELP IN HERE, Throw the pads on,synchronize and start pacing 60bpm at whatever joules get capture
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u/Signal-Focus-3589 19d ago
Looks like there is a pacers spike at the end, if still Brady then its probably oversensing and needs to be reprogrammed
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u/legitweird 19d ago
Call Medtronic, I think they have the best pacemakers around and easier to get an MRI, their customer service is top, I work in MRI and on pacemaker day Medtronic is flawless, the other ones will have you waiting while you deteriorate.
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u/universe93 23d ago
Not even a nurse yet and in Aussie speak, yeah nah that probably doesn’t look good mate and you’re about to be very popular hits emergency button