what are some typical ECG dysrhythmia progressions you have seen often?

ClearBlueOctoberSky · Feb 1, 2012

I have seen ST go to AFib, back to sinus, before the guy went into VFib. He had a syncopal episode earlier in the day, declined transport to the hospital. As we turned him over to the transporting FD, we tried to tell them what we were getting on the LP12, they saw him in a Sinus Rhythm and declined our strips. He went to VFib as they rolled him into the trauma bay at the ER. When we got him, he was diaphoretic, c/o CP, decreased LOC. Turned out he had a huge saddle PE.

In CORs, it is normal to see a transgression from VT to VFib.

You also might see Atrial Tach progress into AFib. Especially in the older population. I have saw it the time when I gave my LOL a continuous Albuterol neb for difficulty breathing. (Paramedic at the time.)

Enjoy your EKG class. Cardiology has always been my favorite. I was disappointed in the class that they gave in my LPN program. Not enough meat. The excuse: You won't be taking care of these patient's anyways. :no:

tokmom, BSN, RN · Feb 1, 2012

I have seen pt's bounce from A-fib RVR to sinus and back to A fib.

SR to SVT, back to SR

My favorite a second degree type 2 block went to a third. The 94 yr old woman was a no code and refused a pacer. We dc'd her to a SNF with a HR of 36 the next day. She was a/o x3 and up in the room with SBA. I wonder what ever happened to her. It was an amazing strip though.

Guttercat, ASN, RN · Feb 1, 2012

I was wondering if anyone would like to share what ECG dysrhythmia progressions they had seen.

Anecdotal (and purely for lighthearted, Tues night self-indulgent fun):

My baseline is NSR.

However I met a man (bad idea) once, who induced ST in me (which felt like a good idea at the time), but my SA node got away from me and it progressed into A-fib w/ RVR... ooops.

Man (bad idea) went away (bastid), and unfortunately my SA node could take no more. The AV node and Purkinjes blew a fuse; the LV suffocated and an Agonal rhythm was deadly the result.

I have a few, stalwart friends that are still throwing Atropine and Epi my way as I turn blue, and make gurgly sounds while I blow bubbles around my ET tube.

unsaint77 · Feb 1, 2012

Just in time, a DDD pacemaker kissed your heart and brought you back from the dead, and you two lived happily ever after. Aaaaaaaaaaaaaah. Sniff sniff.

unsaint77 · Feb 1, 2012

Hey Ambigirl and Tokmom, do you think there was short A-flutter between the SR and Afib, but lasted two short to be seen?

6spdftwtm · Feb 1, 2012

The first thing I do in the ER with any MI is slap some combi-pads on them. STEMI's are notorious for inducing some wicked ventricular arrythmias. They go NSR c ST elevation → VF → ZAP! → NSR c ST elevation. What's especially creepy is when someone goes into VF and they continue to sit up in the bed and talk to you for a few seconds. VF isn't exactly conducive to cerebral perfusion. LOL.

And yes, VT will 99% of the time decompensate to VF and then asystole. The majority of junctional rhythms I have seen have been accelerated junctional....which is something you can easily mistake for NSR if you don't look very closely at the ECG monitor. A 12-lead picks it up with no problems. The few truly junctional rhythms I've seen have been during codes, which quickly progress to agonal or asystole.

I've also witnessed several clients in a-fib (with and without RVR) flip-flop with NSR or SB.

Late,

Trav