Here is an absolutely fascinating case submitted by G.W. Lyster (who credits the case to J.C. Neetz).
It's a patient who presented with a wide complex tachycardia who ended up receiving the kitchen sink!
Here are the basics.
44 YOM C/O "palpitations". Denies CP, SOB, N/V, dizziness, weakness. Pt in NAD.
Meds include Coreg, et al. (poor historian on meds) No allergies. Hx MI 8 days ago with stent, MI 5 years ago with "rapid heart rate".
P228, R20, SaO2 98, BP 160/102, BS 116, Skin WPD
Here is the initial rhythm:
Here are the 12 lead ECGs:
During the course of treatment, the patient was shocked at 100, 200, 300, and 360 Joules.
Here's an example:
After the unsuccessful shocks, the patient received lidocaine, adenosine, and procainamide! This particular service does not carry amiodarone.
Here is the code summary.
At the emergency department, the patient converted post-amiodarone.
Here is the patient's disposition:
Supervisor was able to obtain the following:
ICU Dx with recurrent arrythmia. No further episodes. They decided he had a non-acute MI (unknown age). He will get a consult to determine if there is a conduction issue (re-entry rythym). The Cardiologist thought he may have a WPW, but he will need the follow up with a specialist in regards to further exploration of the conduction pathways.