54 Junctional Rhythms

(42:27) Move’n on down the heart we get to the AV node and junctional rhythms this week. We also talk about the ACLS tachicardiac algorithm and stable vs non-stable patients.

Also Kelly summarizes all the pediatric course like PALS in 30 seconds.


Six Second ECG
Sex Relationships and the Cardiac Conduction System
Taigman’s Advanced Cardiology (In Plain English)


Listener Questions

Susan – I live in los angeles and really want to go to UCLA paramedic school however the cost is significantly more than other schools in the area . How important is the place you choose for P school to an employer?. If they are all accredited then are they all the same in value. I want to make sure I’m marketable once I graduate, but it might mean waiting a lot longer to start since I’ll need to save more money. I’d love to hear your thoughts..
The public EMS system I work for leans towards the paramilitary side of the spectrum. We’re talkin’ dress uniforms with plenty of bling (including a badge), assigned “ranks” for each position in the organization, and a thick policy book dictating behavior and dress at special events (down to the placement of name badges, award pins, and so on). While this can be cool for the medics and EMTs who enjoy that type of thing, I just don’t see how this benefits the patient. My question: how common is it for EMS systems to be paramilitary? And what is the justification for being this way? How is it supposed to help the patient? – Alex
Scott – Hi, I’m in paramedic class, we jus t finished the cardiology section a couple weeks ago but recently I had an interesting case on ED clinical. I tried asking my instructors about it, but they said they would just call command for answers. How would you handle this in the ambulance?

75 yom complaining of chest pain, you initial impression is that he going down the crapper. On the monitor you see a paced rhythm at a rate of 56 beats per minute (with electrical & mechanical capture). All signs point towards that the heart isn’t beating fast enough to adequately perfuse the body. BP floating around 85/50.

Would you trans-q pace the patient? The crew that brought the pt in didn’t nor did the ED doc.

Kelly, I just took PHTLS this last week & talking with the instructor, they DON’T have a separate test for EMT-B’s they take the same test as Medics & are scored on ALL the questions including the ALS ones. when I was team leader for the scenarios we had I would say that I would have one of my medic partners handle the ALS procedures(starting IV’s, doing needle crics, & chest decomps, etc) & I stuck with doing the BLS ones. One question though, I was thinking about taking either PALS or ACLS, since I’m a Basic would I be in way over my head if I took either one of those ?? I’m also thinking about taking AMLS would that be a good idea as well – Kenneth

2 thoughts on “54 Junctional Rhythms”

  1. Ron, I fully plan on going on to Medic school after I get back to work with an EMS agency. Kelly, I will keep my eyes open for a PEPP class near me unfortunately there isn’t one right now.

  2. I have a question for your next episode, or whichever episode you decide to put it in really.

    How strong physically would you say you have to be to be a successful EMS professional? I have been wondering this for so long, I am not really that strong but love medicine and the concept of EMS and can’t wait to start–but I’m just worried I won’t be able to cut it physically.

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