Wide and Bizarre

Over the years I have written numerous times about SVT & TVS (or a similar iteration). Depending on the urgency, the disease process, or even the on-site knowledge base, wide complex tachycardia can present a conundrum, in terms of proper naming of the rhythm. In the event that the patient is critically unstable, cardioversion may be the best choice of therapy.

Wide and Bizarre

It's the middle of the night
And you are a newbie,
You're dead asleep
And dreaming about Ruby,
When your pager goes off
For the CCU,
It seems that Billy Bob Borko
Had some dying to do.

The nurse asks, Doc
Will you look at this for me?
Billy passed out
When he was taking a pee,
And you notice his rhythm
Looks wide and bizarre,
Enough room for a semi
And a Mini Cooper car.

Is it SVT or TVS
If you don't know
You won't impress,
The Attending physician
In the morning meeting,
You better talk to the nurse
Before you take a beating.

There's a guy at the desk
With arm raised and beckoning,
Don't bother to argue
Or there will be a reckoning,
A teacher of EKG
With 30 years of knowledge,
You're not even that old
After eight years of college.

Sure, he can't name a diagnosis
His license won't allow,
But his barrels of experience
Are available, like free chow,
And any self-realized
Brand new doctor,
Will understand free
Without asking a proctor.

Don’t get your knickers in a twist
If he knows more than you,
Regarding Torsades de pointes
And accessory pathways too,
Just sit down and listen
Maybe take a few notes,
On rounds, in the morning
You might get all the votes.

If the Attending should ask you
To cite an article or source,
Please do be honest
Don’t be the butt of the horse,
Embarrassed to admit
A nurse explained it last night,
Let’s have mutual respect
Because payback might bite.

SVT or TVS,
Beguiles folks
You must confess,
If you’re haven’t learned
The nuances and rules,
Your Attending will know
How to separate the fools.