The eye does not see what the mind does not know.
It's 02:00. Your new SHO comes to you to discuss a patient they've been asked to review with palpitations, and has questions about the patient's ECG.
Which of the following should you give amiodarone to?
The answer is NONE of them.
Amiodarone is not some wonder drug that cures all arrythmias.
There will be some situations in which if you blindly give this drug, it will come back to bite you.
Hard.
Hindsight is 20/20.
And yet, to be forewarned is to be forearmed.
There are some ECG patterns in which treating them generically will result in catastrophic consequences.
Who should attend this course?
-
Those who are comfortable and understand the concepts explained in both my "from the ground up" series and "ECG course - part 1".
-
This is the more advanced side of the course, focusing upon arrythmias and their complications. What happens when you fall off the algorithm?
-
This is therefore more valuable to those who are more senior in their role or experience, or indeed those who wish to understand more about the electrical abherrancies that can befuddle the heart.
-
The focus of part 2 is upon the electrical systems of the heart. Thus, the wonders of bradyarrythmias, tachyarrythmias and other bizzare pathologies fall under this section.
Why should you attend this course?
-
The situations found within this side of the course are generically rarer than in day 1. Nevertheless, as the eye does not see what the mind does not know - it is a disservice to the patient to fail to identify rhythms which require special treatment plans
-
We also explore the rationale behind those special treatment plans. Why do we do what we do, and indeed - what to do if it still goes wrong?
-
Unlike STEMI/OMI where the goal is identification and communicating with the cath lab, the conditions we cover on this side of the course are going to be initiated by yourself. You therefore need to be certain of what it is you are facing, and convince your team when they are in unfamiliar territory.
What do we cover?
ECG part 2 List
Bradyarrythmias:
ALS belongs in the bin sometimes. Atropine will not always save you. Understand why the heart is mis-behaving, and you can logically approach the complications if and when they occur.
The emphasis in this section is both on pathophysiology, and thereby understanding the interventions we are giving and their common failure points.
Once we have explored those failure points - we discuss strategies to counter act them.
Arrythmias.
The "Advanced" in "Advanced life support" is subjective, relative to "Basic life support".
In reality, there are so many situations in which the protocol will not save the patient.
To be pre warned, is to be prepared.
VT, or not VT?
No ECG workshop is complete without talking about this subject.
VT vs SVT with aberrancy - I will explain the premise and methodology behind it, what tools are avialable and their heavy caveats.
By drilling down to the pathophysiology, and diving into the literature, you can understand, and thus make your own informed decisions when faces with this situation.
Bundle Branch Blocks.
"William" and "Marrow" are crutches that denote a lack of understanding.
By going breaking it down to the actual physiology (which i promise you, if i can do it, so can you!), you can run, instead of hobble when faced with these.
In this section, we also face the (in)famous myth of the trifascicular block.
VT - Special circumstances.
Do you know when Adrenaline is contraindicated in arrest?
Do you know how to give Adenosine for VT without being sectioned by your colleagues?
No?
Well you will after this section of the series!
Syncope:
The collapsed patient gets an ECG as part of their work up - but do you know why?
it provides many clues towards what the cause might have been, and we will go through them in this section.