March 24, 2023

#Paramedic #EMT

Okay let’s talk tak e anyway and there’s a lot of information about tacky out there it’s very confusing and you’re gonna get a lot of very confusing information talk to you but i’m gonna try to break it out a little differently for you because the way i wrote protocols is different than the way the nr emt wrote their protocols okay i try to be very concise and

Logical and line it up so you can very clearly see what’s important to that topic okay i try to isolate it i try to bring it forward and if you want to pick up a copy of protocols or any of my other books you can go to the click on books it’ll take you to the packages these are the individual books they’re cheap individually i want you to have

Them you can get the packages too the ultimate medic kits that come with the 100 nr emt test pass guarantee okay i’ve got it all for you in there now when you look at protocols this is ultimate protocols right and and and you look at brady and you look at tachycardia uh in the bradycardic video i showed you there’s really two types of bradycardia sinus and third

Degree heart block there really isn’t too much other bradycardia that you’re going to be dealing with right but then we look at tachycardia and suddenly oh my gosh look at all the options we have and that’s and that’s what this video is about because what’s the treatment for bradycardia atropine one milligram uh and and vaso you know what i mean like a vaso

Compressor so you bring up the blood pressure and pacing sedation you know and almost volume and oxygen don’t even count saline and oxy because you have to do that with tacky too because it doesn’t matter if they’re brady or tacky they’re both cardiac insufficient which ends up being the same signs and symptoms lethargic head nodding head slump pulseless so

Same same ending pathway head nodding slumped boom pulseless prone on the floor passed out right the thing is that there’s nothing to do for brady but some atropine and pacing but tachycardia is a little different so let’s let me show you very clearly and focused how tachycardia is going to be a little different okay so tachycardia has more protocols tachycardia

Can also be uh in the atria or the ventricles or some combination of both and this this here is the management protocol so it has the basics for all tachycardia in it right so tachycardia they’re going to be hypotensive what are we talking about for all types of tachycardia there you go you give them a fluid bolus tada now gf3 dehydrated if they’re 130 124 136

Beats per minute and you give them a liter of saline and they come down to 100 perfect that was dehydration that wasn’t tachycardia tachycardia is cardiac in nature it is not compensated shock because what’s compensated shock what’s compensated shock compensated shock right there compensated shock is specifically increase in heart rate it is compensated with

An increase in heart rate so if you give them fluids and their heart rate came down congratulations it’s one of the few things that ems can actually fix his dehydration so you got it you caught it you got the right call you did the right thing turf them okay now let’s talk tachycardia where the problem is cardiac okay and we can start with atrial tachycardia

There’s a couple of tachycardias that you have to know about the atria you’ll have to know afib afib with the berensi you’ll have to know what psvt is an atrioventricular nodal reentry you’ll have to know a wolf parkinson white narrow you’ll have to know a couple of things you will have to know more things for atrial tachycardia than three bradycardias you know

What i mean there is just so much happening with tachycardia other than atropine and pacing okay atrial tachycardia rhythms somewhere in the atria whether it’s quivering with afib or it’s multifocal atrial tachycardia where the foci could be ha shiny balls anywhere in the atria it could even be retrograde from the ventricles with av nrt okay forget that forget

That all right you could have you could have an alternate non-sinus foci in the atrial i just like saying foci okay afib afib with the berensey psvt wolfe parkinson white that’s your atrial tachycardias okay now there are more tachycardias oh there are more tachycardias because we haven’t even got past the av node into the ventricles more ventricles than atrial

Tube okay now atrial tachycardia um with atrial tachycardia we have a fib here’s psvt wolf parkinson white afib and and and afib with the berensing now what i’ve done what i’ve tried to do for you here is with psvt i put this little mad here and that’s because i want you to remember it’s metaprolol adenosine deltaizem see the three meds right here these three

Meds right here see these three meds those they’re they’re they’re anti dysrhythmics because a dysrhythmia could be atrial or ventricle so they’re everybody’s like oh give them some antidotes rhythmics there’s there’s six here’s three now forget forget what the action is they’re telling you to use this to solve an arrhythmia okay so we’ve got three of them here

So so psvt you’re gonna get mad metaprolol adenosine deltaism all right you you’re going to be using adenosine you’ve never you know what i mean like i just came out of acls and nobody said metaprolol or delta is them but that’s that’s it okay now of course uh if they’re unstable i mean we’re back to electricity although it’s not pacing now we’re shocking if

They have pulses you’re gonna you’re gonna do uh a shot a shock but a synchronized cardioversion where you set it in shock mode you make sure the hash marks on the highest point of the queue on the r and and then you’re going to let it shock at the highest point because you don’t want the shock on the t you don’t want an r on t phenomena because then it breaks them

Into b fib listen it crashes the internet someone’s going to have to clap back you don’t synchronize cardioversion with a pulse if it’s atrial it’s going to be 50 if it’s ventricular the first shock is a hundred so even if you’re going to shotgun ventricular right here head slumped with pulses start at 50 atria okay now wolf parkinson white with wolf parkinson

White we’re now at pal pal is now going to be procainamide amiodarone and lidocaine we’re using we’re using five different meds six meds adenosine we got mad if it’s a narrow qrs and we’ve got pal if it’s a wide qrs okay mad narrow pal wide all right now we go to afib which is usually narrow and while we can’t do adenosine because they have enough of that problem

You’re still going to get damn mad dm dough ties them in mouth problem so clever of me otherwise you’re going to have to shock them right so with afib we’re going to get damn with with with something atrial and narrow which is afib because it’s not a ventricular problem it’s a conduction problem it’s a atrial problem so afib uh these are metaprolol delta zem and

If it’s narrow you’re going to do it’ll be psvt you would do adenosine uh if there’s a p wave with a narrow qrs now afib with the berensey is now a wide qrs it’s a fib which which gets us right mad menoprolol and tizen and afib with the burn c is going to be pal whether you have lidocaine in there or not right it’s going to be that pal so you’ve got a pal with

An aberrancy which is a wide qrs you have a pal with a wolf wolf parkinson white which is even though it’s regular like psvt it’s going to be wide so why qrs pal narrow qrs mad wide qrs i mean even though it’s the lidocaine right i mean okay ventricular v-tach with pulses oh is v-tac wide i forget oh if it’s a wide qrs i’m going to be doing procainamide

Amiodarone lidocaine if it’s v fib right i’m going to be amiodarone lidocaine now listen i’m sure that somewhere in in the translation that maybe there’s a lidocaine option or or or a procainamide option like i’ve never seen nor epinephrine yet it’s everywhere you know what i mean oh my god epi norepinephrine anything we’re using a vasoconstrictor like dopamine

But i’ve never seen norepinephrine so maybe procainamide goes in here with it too i’m not that smart what i’m getting at is if you want one clue to remember which anti-arrhythmic to use it is not the trick is not to memorize them okay i’m going to use procainamide amiodarone and lidocaine with wolf parkinson white uh afib with the berensi uh no no here’s the thing

You’re gonna do your pals your procainamide amiodarone lidocaine with white complex qrs and you’re going to use your your your uh your your damn mad right your psvt right here your metaprolol adenosine endotheism with narrow qrs it doesn’t matter what the rhythm is if it is if it’s fast and it has a narrow qrs it’s metaprolol adenosine endotheism metaprolol i

Mean you’re not going to use the adenosine on this one because it’s afib but i mean right here as soon as you get into a ventricular i mean you’re it’s almost assuredly going to be wide especially if they’re going to be symptomatic right like that’s not even that’s not right that’s not even something you’re going to use so here let me show you vtac sinus attack

Narrow if it’s narrow you’re going to be you’re going to be mad metaprolol adenosine totalize them it’s narrow uh ventricular attacker wide complex oh white complex you’re going to be my pal procainamide amiodarone light a cane even if i was to show you uh svt with a berensi i don’t even think i have that here’s a v-tack here’s another v-tac is it wide it’s

Gonna be my pal if it’s wide procainamide amiodarone lidocaine oh it’s gonna be oh it was narrow oh i’m gonna get damn mad metaprolol adenosine deltaism and if it’s and if it right and if it’s afib with the narrow you’re going to use metaprolol endotheism because if it’s afib with the berency what happens when you get wide complexes what meds do you use oh why

Complex meds are my pal procainamide amiodarone lidocaine antiarrhythmics for wide complex qrs’s and metaprolol adenosine and deltazem for narrow complex cure what rhythm is it i don’t know if it’s fast and it’s narrow i’m going to use metaprolol adenosine endotheism if it’s fast and it’s wide i’m going to use procainamide amiodarone and lidocaine yeah there’s

Some subtle differences but right now after watching this video i know you will be on the street you’ll be like oh it’s a white complex that’s my pal are you going to give him some procainamide and the medic’s going to be like oh do we have you i’ve never seen procainamide oh well maybe we should use some amiodarone or lidocaine and they’ll be like okay how we got

That on the truck let’s do lidocaine they’d be like how much you’re gonna be you know what do we do a little 300 do a little 300 bolus maybe a little 300 trip he depends here they have pulses not at pulses but but just understand when you look at this this could be v-tac with pulses it could be vtec without pulses you won’t know until the proctor your instructor

Tells you or you check the patient but it doesn’t matter it’s wide complex tech it’s wide complex tachycardia what are you going to use yes white complex tachycardia is my pal procainamide amiodarone lidocaine and narrow complex qrs makes me mad metaprolol adenosine deltaism because because i broke out because an acls class today and i got to tell you i even i’m

In the last you know i’m always working on my books making it smoother i go take like an acls class or my pals researcher or whatever there’s always little tips or tricks that people connect with me that i can always add in so i’m in my acls class when i’m i’m fresh off of reading watching all the videos i finally understand what they’re talking about because the

It’s insane the information they give you i can’t process it it’s it’s crazy making so now that i’ve got it all straightened up i’m in class demo oh heck yeah i’ve got this i’m all i am all over it it is svt and i’m like did you guys want to do some amiodarone or lidocaine as an antirhythmic nobody said anything and i’m saying it and i’m like nope that something’s

Wrong and so i went and i grabbed my book and i checked it i’m like you know what you know what hang on a sec and nobody corrected me so it occurred to me that there has to be some way to figure out when to use the two meds so came home sat down or it’s already organized so i just looked at it what were the similarities and that was how i ended up doing this

Video today about about you know you want to get mad if it’s a narrow qrs right and you you look white qrs are pal and you’ll never forget again procainamide amiodarone lidocaine i’m the ultimate medic listen if you liked this book you can go to my website the i’ve got videos about this protocols i’ve got assessment books click on books i’ve got

Nr emt 100 first time test pass guarantee the books are inexpensive i want you to have them here’s the kits that come with that first time test pen pest pass guarantee you like the information i smooth it out for you i know you’re sitting in class and you’re like oh you can think about my videos you’re sitting in class and you’re just like i i am just no idea what

You’re saying anymore after watching the ultimate medic lay it out for you you’re gonna go you’re gonna read something in a book and you’re gonna be like you know what you know what you don’t you don’t there isn’t anything that in your school books that i don’t have in my school books right so the nrn emt has this much information i have all that information in

My books and then some and it’s clearly laid out to present it to you i want you to win i want you to be able to work out on the streets ems it’s a brilliant job best job ever they need you more than ever now with corona so go get it done thanks for watching say thanks richard

Transcribed from video
Tachycardia- medications made easy Adenosine Metoprolol and Diltiazem By the ultimate medic