I haven't posted in WAY too long. I've been busy as heck… but not THAT busy. I'll get back on it. Don't worry.
However, in the mean time let me tell you about something I read today that really got me thinking about a common condition we see every day in the field we probably don't think much about.
David Baumrind, one of the fine contributors to the ems12lead blog wrote an excellent and thought provoking piece on the physiology of the supraventricular tachycardias. It made me think about some things that I had filed in my brain under "already know and don't need to review very often" and reexamine them. You should read it too.
I did a year working part time for a company that brought out a long term heart monitoring device a few years back. My job was to read the 3 to 14 day EKG tracings that the patients from primary care and electophysiology clinics wore in order to catch their potential cardiac issues. I read thousands of long-term rhythm strips and cut out the interesting segments to put into reports. It was an excellent learning experience and really opened my eyes to the gymnastics our hearts go through in the course of a normal day. I saw patients that were in and out of what I used to consider very pathologic heart rhythms multiple times per day, every day, without even a hint of a symptom. The devices the company invented had a button for patients to press when they felt symptomatic and also provided a diary for patients to use to record their sensations while on the device. It amazed me that people could be in and out of severe tachycardias up to and including V-Tach as well as many other heart rhythms for incredibly long periods of time without having so much as a dizzy spell recorded in their diary.
Since then, I've been very judicious about emergently treating a tachyarrythmia in the field without a clear-cut reason to do so. I've found that there is almost always an underlying cause that can be corrected or at least time to prepare the patient before doing anything drastic. Remember, all of our antiarrhythmics are "Selective Cardiotoxins" as Rogue Medic so eloquently describes them and are not benign when given inappropriately.
So go read this post at the ems12lead blog. It's a good refresher for all certification levels and it might just make you rethink some things. I did: