A 86-year-old with pneumonia develops this telemetry pattern. Electrolytes are normal, no culprit drugs, and no cardiac history. What rhythm are you seeing, and what would you do next?

If I am ever this 86 year-old patient, I beg you to do nothing.

Excellent case of artifact confirmed by QRS complexes marching through and a regular pulse seen next to the SpO2 reading.

Just look at SpO2 pulse rate on right bottom corner, shows regular rythm even during the ECG alteration ! Artifacts!

Artifact, 100%. Watch lead 1 only. QRS complexes march right through.

That’s artifact, baby. SpO2 signal is regular and much slower than the ECG trace.

Artifact and there's clearly regularly spaced QRS complexes in there. You should not be teaching people that this is torsades

Torsa de pointes. IV magnesium sulphate

Interesting , i just want more elaboration from our colleagues who supports the ‘artifact’ , in all available leads we can see a persistent finding of irregular wide complex tachycardia for dd, you might say tdp or af with aberrancy , but for me the artefact was interesting

Probably ask why the patient is being tazed

Pulse is 85/min and stable durnig "TdP". 100% Artefacts

The telemetry sparked a great debate. What's your interpretation?

Artifact , but also why is everyone calling it Torsad how do you know its torsad and not polymorphic VTach?

Unstable polymorphic VT / TdP → immediate unsynchronized defibrillation and NOT synchronised cardioversion!! In unstable torsades de pointes (TdP), you generally do not use synchronized cardioversion because TdP is a polymorphic VT with a continuously changing QRS morphology.

Is there a pulse?

Torsades de Pointes Treatment • IV magnesium sulfate (2 g) is the first-line therapy. • Correct hypokalemia and other electrolyte abnormalities. • Discontinue QT-prolonging drugs. • For recurrent episodes, increase heart rate with temporary pacing or isoproterenol. •Immediate defibrillation is required if hemodynamically unstable.

Rigors. The pulseox is regular and about 80- 110 bpm throughout the 'tachyarrhythmia' Look at the pt output or no and add in the pulse oximetry trace. Also if was Vt or Vf then wouldn't be standing around admiring it

I think it’s artifact. You can see some breakthrough qrs complexes.

Check it's not artifact? BP looks pretty good for someone with TdP. 🤔

artefacto, pero mirar a la cara al paciente en vez de la pantalla, seguro que nos sacaría de dudas

If you see a qrs on any lead it’s not torsad

Pt shivering.

Torsades de pointes A polymorphic ventricular tachycardia associated with a prolonged QT interval, characterized by cyclic twisting of the QRS complexes around the isoelectric line on ECG. It may cause syncope or sudden cardiac death and is treated with intravenous magnesium sulfate, correction of electrolyte abnormalities, and withdrawal of QT-prolonging drugs.

86 man brushing teeth rhythm

Torsades de pointes

Artifact.

Artefacto. Y no pienso discutirlo con nadie.

Artifactcardy🫀

I'm brushing my teeth.

It could be TdP, but the history is not convincing. Not VF as it seems to self-terminate. Given it seems to march through even when there ar clear QRS complexes, I'd probably say some sort of tremor. Maybe rigors given the waxing/waning pattern? Of course I'm the pharmacist..

Torsad de point

🤣 SR 84bpm…

This looks like CPT…. Very commonly seen if you take care of CF patients.

Torsade's de pointes; give IV Magnesium Sulfate

Torsades de pointes. But before fully committing, I'd also make sure patient wasn't shivering.

Congratulate RT on effective vest or OLE therapy