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Medical: 5

Cardiology: 2 ════════════════════════════════════════════════════════════════════════════════════ ══════════════════════════

a. b. c.

d. e.

f. g

.

Idioventricular rhythm Accelerated idioventricular rhythm Premature ventricular complex (ventricular ectopic)

  • (1)

    R on T phenomenon

  • (2)

    Paired/ couplets

  • (3)

    Multiformed

  • (4)

    Frequent uniform

"Rule of bigeminy" pertaining to precipitating ventricular arrhythmias Ventricular tachycardia

  • (1)

    Monomorphic

  • (2)

    Polymorphic (including torsades de pointes)

Ventricular fibrillation Ventricular standstill

8.

9.

h. Asystole Abnormalities originating within the bundle branch system

  • a.

    Incomplete or complete

  • b.

    Right bundle branch block

  • c.

    Left bundle branch block

Differentiation of wide QRS complex tachycardia

  • a.

    Potential causes

    • (1)

      Supraventricular tachycardia with bundle branch block

    • (2)

      Accessory pathways

  • b.

    Differentiation

    • (1)

      Physical evaluation

      • (a)

        Cannon AA@ waves

      • (b)

        Vary intensity of first heart tone

      • (c)

        Beat to beat changes in blood pressure

    • (2)

      ECG differences

      • (a)

        Aberration as a result of premature atrial complex

        • i)

          Identify PAC in previous ST segment or T wave

        • ii)

          Sudden change in rate with bundle branch aberration

        • iii)

          Concealed retrograde conduction

        • iv)

          Right bundle branch refractoriness - may be time dependent

        • v)

          Compare with previous ECG, when available

      • (b)

        RBBB aberration - V1 - positive

        • i)

          Biphasic lead I with a broad terminal S-wave

        • ii)

          Triphasic QRS in V4

      • (c)

        LBBB aberration - V1 - negative

        • i)

          Monophasic notched lead I

        • ii)

          Slurred, notched or RSr= in lead V4,, V5, or V6

      • (d)

        Concordant precordial pattern

        • i)

          Totally negative precordial pattern is diagnostic of ventricular tachycarida

        • ii)

          Totally positive precordial pattern is suggestive of ventricular tachycardia

      • (e)

        Preexisting BBB prior to onset of tachycardia (by history)

    • (3)

      Other considerations

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────────────────────────── United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum

17

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