Enigmatic rhythm: swift action is key in complex cardiac case

This was an interesting, yet enigmatic, case. An elderly male with a prolonged QT interval developed a third-degree block with a slow ventricular rate. This spontaneously converted to a polymorphic v tach (probably torsades) that worsened his cardiac output causing pulmonary congestion and hypoxia. He ultimately converted back to a third-degree block following treatment with amiodarone and magnesium sulfate. More importantly, paramedics recognized the complexity of the case and, because of the very short transport time, elected to rapidly transport the patient. Complex cases such as this do not fit into any standardized EMS protocol. Because of this, we need paramedics who see and recognize serious conditions that don't fall within the constraints of algorithmic protocols. In this case, they identified the problem, transported promptly and alerted the staffin a busy ED of the patient's complex and deteriorating condition.