This is simply artifact.
I used the calipers to map the RR interval. By doing this you can see which complexes are conducted beats and which are artifact.
It would be highly unlikely for a narrow complex tachycardia to have a rate of 300 outside the presence of an accessory pathway.
P waves are present but difficult to make out with presence of artifact.
A simple way to conclude the presence of artifact is by checking for a mechanical pulse.
Addition by Rogue Medic 00:17 9/18/09.
My little bit of strip marking to show what I was looking at with this strip. These are just different ways of coming to the same conclusion. In EMS there is rarely just one right way of doing things. The response of the patient is the best indicator of what is right. Sometimes nothing is right.
.
I think next time I'll go with my gut! I do enjoy when we break out the rhythm generators and shake the wires to make the monitors ding during scenarios.
ReplyDeleteI couldn't post my strip in the comments, so I stuck it on the end of the post.
ReplyDeleteNice addition RM.
ReplyDeleteAdam,
ReplyDeleteThank you. I didn't change anything from the original one I sent you. You showed one way to conclude it is sinus, while I showed another. There ought to be more ways.