Escape beats

A 68-year-old man developed total spinal anesthesia after the administration of 20 ml of ropivacaine 1% without a prior test dose via an epidural catheter, which was inadvertently placed intrathecally (83). Initial aspiration of both the Touhy needle and the catheter failed to identify the intrathecal position of the catheter. The patient noted weakness in his right leg immediately after the end of the injection. This was followed by weakness in his right arm, asystole, apnea, and loss of consciousness. Ventricular escape beats were noted and sinus rhythm returned after mask ventilation with 100% oxygen and the administration of atropine 1 mg and ephedrine 50 mg. He was able to open his eyes, but remained apneic and was therefore intubated and ventilated. Cardiovascular stabihty was maintained with incremental boluses of ephedrine to a total of 60 mg. He regained consciousness and was successfully extubated 145 minutes later. AH sensory and motor deficits had resolved within 8 hours and no neurological deficit or transient neurological symptoms were detected 5 days later. 

Stable Strontium. Cardiovascular effects of strontium have been investigated by intravenous infusion studies in dogs. Infusions of strontium (as chloride or gluconate) averaging 172 mg strontium/kg under conditions of lowered potassium induced accelerated ventricular escape beats, ventricular tachycardia, or atrial fibrillation (Foster et al. 1977). High levels of strontium also induced oscillatory potentials and... 

The pause isn t a multiple of the underlying P-P intervals Junctional escape beats may occur at end of pause... 

Antiarrhythmic drugs (such as amiodarone, lidocaine) contraindicated for idioventricular rhythm because of possible suppression of escape beats... 

Atropine contraindicated, especially when accompanied by wide-complex ventricular escape beats... 

If the sinoatrial node fails to generate an impulse, the AV junction may take over and initiate an escape beat, as mentioned earlier. These escape beats are the hearts back up system to keep the heart functioning (Fig. 6.25). 

A tachycardia made up of three or more Premature Junctional Beats. Junctional Tachycardia is usually caused by the AV node taking over as the dominant pacemaker due to enhanced automaticity. As in junctional escape beats the atria are retrogradely depolarized, resulting in inverted P waves that can occur after the QRS complex. 

Otherwise known as Complete Heart Block (CHB). This is due to the inability of any atrial impulse to pass to the ventricles. The presence of escape beats prevents ventricular standstill (P wave Asystole) occurring. The principle ECG characteristics consist of complete atrial/ventricular disassociation. There is no connection between the P waves and QRS complexes. P waves occur without preceding QRS... 

Complete SA block otherwise known as sinus arrest has no such mathematical relationship. The pauses can last several seconds, and may cause patients to collapse (Fig. 7.15). The pause is normally terminated by an escape beat. As discussed earlier these escape beats originate further down the conduction system and are known as junctional or ventricular escape beats, depending upon their origin. These beats act as a safety net preventing Asystole. Treatment may require the use of drugs such as atropine or the insertion of an artificial pacemaker. 

Ventricular escape beats or complexes When fewer than three QRS complexes arise from the escape pacemaker. 

RED FLAG Never treat an idioventricular rhythm with lidocaine or other antiarrhythmics that would suppress the escape beats. 

A greenhouse gas is any component of tbe atmosphere that allows visible solar radiation to reach the Earth s surface but prevents invisible infrared radiation (beat) from escaping back into outer space. This mimics the warming action of a greenhouse. If it were not for the atmosphere s greenhouse effect, Earth s average surface temperature would be a chilly -i8°C. 

People who abuse prescription drugs may escape detection for years because they have learned how to beat the system and obtain prescriptions by visiting different doctors and claiming a different ailment at each... 

A 9-year-old boy whose serum lithium concentration was 1.29 mmol/1 had a sinus bradycardia with a junctional escape rhythm (40 beats/minute), which normalized at a lower lithium concentration (130). 

When she abandoned herself a little whispered word escaped her slightly parted lips. She said it over and over under her breath Free, free, free The vacant stare and the look of terror that had followed it went from her eyes. They stayed keen and bright. Her pulses beat fast, and the coursing blood warmed and relaxed every inch of her body. 

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