![]() ![]() I reassured her that the laceration was minor and only required two sutures to close adequately. Plan: Discussed my findings and diagnoses with the mother. Upper inner lip laceration, requiring simple suture repair. No TMJ (temporomandibular joint) tenderness. The right lower lip above the vermilion border has an abrasion. Superficial skin edges are not opposed, not bleeding. Right upper lip: He had a 1- to 1.5-cm (centimeter) laceration. He has some tenderness and erythema in the right cheek where he was hit, no obvious swelling. PERRLA (pupils equal, round, reactive to light and accommodation). Physical examination: Head is normocephalic. Note the patient normally wears glasses but did not have them for this examination. He also notes that he had a cut on his right lower lip and upper inside of his right lip as well. Immediately following this he had some blurry vision in the right eye, which slowly has improved and is near normal now. The patient states that he did get hit on the right cheek area. Mother is concerned because he is a diabetic and has a couple of lip lacerations, also complained of some transient blurry vision, which has since improved. Sedation should be provided if the patient is conscious as cardioversion is painful.Emergency and Outpatient Record Location: Outpatient, Clinic Patient: Ryan Hoffgrand Physician: Paul Sutton, MD This is a 17-year-old make who comes in after he got punched in the right side of his face. Lower joules are needed to convert SVTs such as atrioventricular nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT), atrial fibrillation, and atrial flutter. This is simply accomplished by pressing the “sync” button that is found on all defibrillators. The shock that is delivered for SVT is synchronized to occur at a precise time during the “R” wave on the EKG, so as to avoid the vulnerable refractory period which could cause ventricular fibrillation. In this case, synchronized cardioversion, rather than defibrillation, is performed. Patients who are unstable, or who do not respond to medication will require electrical therapy. ![]() Patients who are stable may respond well to Vagal Maneuvers to convert them out of the SVT. Patients with an SVT may be relatively stable with few symptoms, or profoundly unstable with severe signs and symptoms related to the rapid heart rate. Patients in a supraventricular tachycardia will have a rapid rhythm with a heart rate greater than 150 beats per minute and a stimulus that originates above the ventricles. Supraventricular tachycardia, or SVT, is far different than the rhythms discussed above, which originate in the ventricles. If it is fine v-fib, you may terminate the rhythm however, if the rhythm is asystole, defibrillation will be ineffective and you can follow the asystole protocol with confidence. If in doubt, it is acceptable to deliver a shock. ![]() As the treatments for asystole and ventricular fibrillation are different, it is important to differentiate between the two. Ventricular fibrillation may be fine or coarse coarse ventricular fibrillation is more likely to convert after defibrillation than fine v-fib.įine v-fib is sometimes mistaken for asystole. On the monitor, v-fib will look like a frenetically disorganized wavy line. In this case, the heart quivers ineffectively and no blood is pumped out of the heart. Ventricular fibrillation (v-fib) is a common cause of out-of-hospital cardiac arrest. ![]()
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