Sinus tachycardia
First Glance:
From across the room it looks like fine VF, then sinus tach.
Discussion:
We’re not going to discuss much here. The sinus rhythm to the right is straightforward, but the beginning of the strip should get your eyebrows up.
This is a false reading due to a lead falling off, which happens all the time, and in an ill patient could result in really bad management decisions if you don’t check what’s going on. I know how hard it is for me to find a pulse on an ill unconscious hypotensive patient, so the first step in evaluating a scary monitor rhythm is making sure it’s the real rhythm. In this case, pushing the lead back on results in immediate ‘ROSC’ and we watch the machine re-zero itself.
Why did both leads die at the same time, and come back at the same time? It’s not because two electrodes fell off at the same time. It’s probably because the ground electrode came off, which is RL. If you are having lead problems, you can often quickly figure out which one is the problem (in the tangle of wires and tubes and blankets) by just examining which leads are affected and thinking about Einthoven’s Triangle to see where the problem lies.
Final Impression?
Sinus tachycardia @ 125 bpm.
Management implications:
Check leads. Electrodes that are popping off can be replaced, secured with tape, pre-prepped with gentle skin abrasion or de-greasing, alcohol, or benzoin. There are also sometimes loose connections on the machine-side of the wires.
The Take-home Point:
Confirm all possibly non-perfusing rhythms clinically because asystole, VF, and VT can all be visually replicated by artifact or lead malfunction.
One star strip. Students should nail this.