tag:blogger.com,1999:blog-18943510.post3861908367333817963..comments2023-08-21T02:57:37.362-05:00Comments on Dr. Wes: EKG Du Jour #21 - The Post-op HeartDrWeshttp://www.blogger.com/profile/17438019699222125477noreply@blogger.comBlogger9125tag:blogger.com,1999:blog-18943510.post-19702508935153925822011-01-10T11:21:54.458-06:002011-01-10T11:21:54.458-06:00I think a Starbuck's is in order while all of ...I think a Starbuck's is in order while all of you cardiac-intelligent sorts figure this thing out.A Lewishttps://www.blogger.com/profile/05066992019067893513noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-69640399339959786542011-01-04T11:48:24.034-06:002011-01-04T11:48:24.034-06:00Dr. Somaratna -
Amio will take a long time to loa...Dr. Somaratna -<br /><br />Amio will take a long time to load and a long time to dissipate - hence why it's not the best choice to treat Torsades caused by the pacemaker in this circumstance.DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-88912259999686698112011-01-04T11:03:35.180-06:002011-01-04T11:03:35.180-06:00Very interesting ! The pacing spikes were the key ...Very interesting ! The pacing spikes were the key clue here.<br /><br />A small question from a 'surgical' doctor - once an Amiodarone bolus is given, won't it take quite a while for the effect to wear off, given it's long half life ?Dr Nayana Somaratnahttp://blog.medicaljoyworks.com/noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-16991368871918782452010-12-28T13:48:22.828-06:002010-12-28T13:48:22.828-06:00Neat set of tracings. One of the potentially distu...Neat set of tracings. One of the potentially disturbing things in this story is that the staff in the ICU (ICU Nurses that were happy, and the ICU intern) were not aware of the potential for this from the earlier set of strips where the pacing artifact was clearly seen to be asynchronous. <br />Where did our training fall down?<br />I know of one EP attending who has lost the patience to train Tedhttp://winslowmedical.comnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-50203084922262531212010-12-23T15:23:30.726-06:002010-12-23T15:23:30.726-06:00Sadly, I'm not a doctor and I recognized the T...Sadly, I'm not a doctor and I recognized the TdP.Lisa https://www.blogger.com/profile/09324961653370110887noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-23664694446052618402010-12-22T20:20:20.562-06:002010-12-22T20:20:20.562-06:00Do you think this indicates an increased susceptib...Do you think this indicates an increased susceptibility to clinical VT/VF in the future?<br /><br />If this were an EP study, he'd have VF with "singles" and might be considered for an ICD on this basis. I'm not sure we could explain this away purely on post op adrenergic tone. Couldn't this type of catachol state occur outside the hospital?<br /><br />I'd still be Jayhttps://www.blogger.com/profile/10897176780069403370noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-49794812096661588112010-12-22T12:57:57.499-06:002010-12-22T12:57:57.499-06:00Ian and Carola -
Nicely recognized.
All patie...Ian and Carola - <br /><br />Nicely recognized. <br /><br />All patients have external temporary pacemakers placed during open heart surgery. In this case, the ventricular sensitivity of the patient's temporary external VVI pacemaker was set to a rate of 60, output of 20 mA and a sensitivity of 5.0 mV.<br /><br />Things were fine as long as the patient was pacing post-operatively. On post DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-38206245968149994702010-12-22T12:26:32.632-06:002010-12-22T12:26:32.632-06:00I see an undersensing of what I guess is a tempora...I see an undersensing of what I guess is a temporary PM used after the CABG. This causes overpacing and sometimes the spike is on the ascending limb T wave, until it starts a torsades de pointes VT. Pacing faster is not a bad idea, this way the native rhythm is inhibited to avoid further S(pike)-on-T phenomena. To be more elegant, I would lower the sensibility and, if it's feasible, I would Unknownhttps://www.blogger.com/profile/16917939637590159449noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-56126407145392307492010-12-22T12:11:38.895-06:002010-12-22T12:11:38.895-06:00Turn off the undersensing epicardial pacer that he...Turn off the undersensing epicardial pacer that he clearly doesn't need!Iannoreply@blogger.com