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Agree: Triage to resus, apply oxygen 15l via NRBM, team approach, assess ABCs and get iv access (exam answer) VBGS to check acid-base and K+ DO NOT give adenosine 12 lead ECG / Full Hx (exclude poisoning)/ obtain old notes & ECG (?short PR) IF suspicion of polymorphic VT give iv magnesium Dunno how old the patient is but I doubt that ventricular rate is a good thing to have for too long. I'm sure I'd end up DC cardioverting although if the patient was comfy and stable I suppose flecainide would be an option to tackle the AF without blocking/delaying AV conduction. -----Original Message----- From: Accident and Emergency Academic List [mailto:[log in to unmask]]On Behalf Of Adrian Fogarty Sent: 17 February 2005 16:28 To: [log in to unmask] Subject: Re: Tachycardic ECG But VT is fundamentally regular; this trace is not! Peter Cutting <[log in to unmask]> wrote: Hmm..... well Could it be bursts of VT overlying fast AF? .........after all capture and fusion beats are 'pathognomic of VT' in all those text books! I have shown this to quite a lot of folk and there are lots of opinions Peter Dr Peter A Cutting Consultant in Emergency Medicine Leeds General Infirmary Tel 0113 3926470 Fax 0113 3922810 >>> [log in to unmask] 15:15:57 17/02/2005 >>> Now that's more like it (couldn't see these on the original trace). Am coming round to Cliff's point of view more and more. Being irregular, it's got to be some form of AF. But with mixed morphology, including capture/fusion beats, suggests an accessory pathway is operating. Are we on the right track? And if so, that's precisely the one situation where you DON'T give adenosine (WPW with AF) I seem to recall (although clearly will make little difference in this particular case). AF Peter Cutting wrote: These any help? Peter Dr Peter A Cutting Consultant in Emergency Medicine Leeds General Infirmary Tel 0113 3926470 Fax 0113 3922810 >>> [log in to unmask] 14:38:51 17/02/2005 >>> Oh, forgot to mention, I can't see any capture of fusion beats. AF [log in to unmask] wrote: At the risk of; i- Bringing the list into disrepute by putting something academic, emergency & medical on it (sorry) ii- Crashing slow non-broadband computers (really sorry) What do you think this ECG shows? (She had a pulse was (and still is)talking, was pain free and remarkably had a systolic of 108) Clearly I know what happened but I am interested in your thoughts, especially re capture/fusion beats Cheers Peter Cutting ____________________________________________________________ This e-mail has been scanned by the StreamShield Protector antivirus system. Doctors.net.uk is used by over 110,000 UK doctors. ____________________________________________________________ > ATTACHMENT part 2 image/jpeg name=Tachycardia.jpg > ATTACHMENT part 2 image/jpeg name=strip.JPG