EMS cliche #1

I recently came across a thread discussing whether a strip was VT or SVT with aberrancy. Never mind that a wide-complex tachycardia is VT unless you can prove otherwise. Just about everyone in that thread was all too happy to call it SVT using a bunch of really questionable criteria that don’t even apply. (Tom – I feel your frustration.)

In this thread, at some point, someone said, “Treat the patient, not the monitor.”

There is no doubt that that is a useful saying in EMS. However, in this particular case, it seems an odd statement to make when the discussion is specifically about the EKG itself. Of course we’re looking at the monitor. (Or, rather, at the tracing on paper.)

Furthermore, what is it exactly that looks different on the patient – other than the monitor – that would determine if it’s VT or SVT? Do patients with VT look different from patients with SVT in a very specific way other than what’s on the monitor? Is there a pathognomonic sign for either one?

Aren’t there VTs – usually the more unstable of the two – that are stable?

Aren’t there SVTs – usually the more stable of the two – that are unstable?

So, how do you look at a patient for the EKG tiebreaker in this case? It doesn’t make much sense.

6 thoughts on “EMS cliche #1”

    1. Interesting stuff, Tom. I also looked at the presentation on Early Reciprocal Changes in AVL. That’s really interesting stuff since we’re usually taught to ignore changes in non contiguous leads. Now I have something else to look at and surprise people with.

    1. of course.

      the irony is shocking may be the most effective option, though a little heavy-handed. besides, if it doesn’t work, no one’s going to argue about asystole. hahaha…

  1. Although looking at the patient will not tell you if the rhythm is SVT or VT, it very well might tell you if the patient needs treatment right now if he can wait a bit bit until you get to the ED. Sometimes doing nothing is the best course.

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