Rhythm interpretation a fib - page 2

Sorry I quoted the wrong person.

If I cant see the waves, then I slow down the speed to see if there's fibrillation. Or look at other leads. When I worked a short time in EP, saw a few AF ablations. Was quite fascinating to see the fibrillation on the fluoroscopy.

Irregular, without a distinguishable P wave. Don't trick yourself into "seeing a possible P wave".

I currently work on a telemetry floor and being a tele nurse means know how to interpret strips... Right? You'd be surprised by how many nurses I work with, where tele is their full time floor have no freakin' clue how I differentiate between SR with frequebt PAC's and Afib. P waves are not discernible in AFib. Think of it like the heart is trying to tell the atrias to contract but they're not too sure... Getting part of the way then pulling back. Thus the quivering " p waves". PAC's are simply another conductive spot in the atrias firing before the SA node. Review the actual conductive path of the heart along side the rhythms and it will clear a lot up!

A-fib, by definition, has P-waves. They can be difficult to recognize since they are fibrillating, but they do exist, typically just as a squiggely isoelectric line. If they truly don't exist, then that is a rhythm that originates lower, such as the junction, which are typically regular. It's the fibrillating p-waves that make A-fib irregular, and often tachy. In A-fib with rapid ventricular response (RVR), the "response" being referred to is response to the atrial hyperactivity.

Most Tele nurses forget that Junctional Rhythms exist. Don't get caught in this trap! Unless this patient's rate was under 50, the rhythm you are describing would be interpreted as accelerated junctional. We get comfortable with our standard rhythms and the rare ones get forgotten.

They are def. not interpreting the EKG strips right! A-fib is irregular, the pt prob converted to a regular rhythm!

A-Fib is, by definition, irregularly irregular. If you see a rhythm that's quite regular in a patient who's got A-Fib and there's no pacer... start looking for junctional or ventricular rhythms. I recall a patient of mine who had AF for years. One fine day she developed a little shortness of breath and some tachycardia. Her pulse was about 160 and very, very regular. She was later determined to be in a very stable VT with pulses, and had been that way for about 4 hours... This wasn't AF with RVR. Too regular. Remember that even AF with RVR will still be irregularly irregular, just faster.

However in the presence of Dig toxicity....you can have a regular AFib