90 year old female with abdominal pain and wide complex tachycardia

EMS is called to the residence of a 90 year old female who awoke to an “uncontrolled bowel movement” that corresponded with sudden onset abdominal pain. On EMS arrival, the patient is alert and oriented to person, place, time, and event. She has a grimace on her face and appears acutely ill. When asked the exact location of her pain she points to the epigastric area. Past medical history: “Cardiac problems” Medications: Numerous (but list unavailable) Vital signs are assessed. RR: 18 shallow HR: Too rapid to count NIBP: 118/60 SpO2: 96% on room air The cardiac monitor is attached. A wide complex tachycardia is noted with a rate of 194.   The patient is immediately loaded on the gurney and relocated to the back of the ambulance where she is placed on oxygen, an IV is established, and the combo-pads are placed. Breath sounds are clear bilaterally. A pacemaker is noted in the upper-left chest. A 12-lead ECG is captured. Atypical RBBB morphology in lead V1 (left bunny ear taller than right bunny ear) with QS complex in lead V6 and right axis deviation.   Wellens’ Criteria Wide and fast rhythms should be considered VT until proven otherwise. Regardless, in this case the morphology strongly favors VT over SVT with aberrancy. See also: 60-Second Soapbox: Wide Complex Tachycardia at Academic Life in Emergency Medicine. At this point the patient’s skin appears grayish, pasty, and moist. Her level of consciousness is diminished and she...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: ems-topics synchronized cardioversion ventricular tachycardia wellens' criteria Source Type: research