Atrial Flutter vs Atrial Tachycardia with AV block - page 3

I am a BSN student currently working as a monitor tech (Also an EMT). Lately I have noticed that many providers (Medics, RNs and even some MDs) just label any rhythm with multiple P waves Atrial Flutter. The way I was taught was... Read More

  1. 0
    Quote from ChaseZ
    What bothers me are the people who do not understand that not all MEn are the same. Like the person who sees ST elevation in leads II, III, aVF and grabs the Nitro because the patient is having a STEMI but fails to realize they are having an inferior MI with right ventricle involvement and destroys their pressure. Oops
    Not all inferiors are true posterior wall MI's.

    The EKG strip? I don't believe that is flutter. There is no "saw tooth" configuration of the atrial activity and the atrial rate is not > 250. The atria and ventricles are beating independent of each other and doing their own thing.....it's AV disassociation, 3rd degree.

    Now if cardiology wants to call it A.Flutter to not address that this is really heart block....ok by me.

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  2. 1
    Quote from Esme12

    Now if cardiology wants to call it A.Flutter to not address that this is really heart block....ok by me.
    Haha! So true.

    Yeah after looking at it with my fiance (CCU RN), we figured looks more like 3rd degree rather than 2nd... p waves march out, AV dissociation.
    Esme12 likes this.
  3. 0
    Quote from IHeartDukeCTICU
    If the P intervals truly march out, maybe a 3rd deg block with atrial and ventricular rates close to each other. Doesn't look like typical A-flutter to me though.
    I'd agree with that. I initially felt it was this however, A flutter doesn't always present in the typical saw tooth fashion. In any cases, sometimes hard to deciper some rhythms due to rates.
  4. 0
    looks like 3rd degree.

    All the conjecture about who misses or mislabels what is just ego-stroking nonsense. Watch your patients, watch your strips and watch your drips.

    Being busy judging other providers will cause you to miss something.

    Then who loses?

    Your patient.
  5. 0
    Quote from 8jimi8ICURN
    looks like 3rd degree.

    All the conjecture about who misses or mislabels what is just ego-stroking nonsense. Watch your patients, watch your strips and watch your drips.

    Being busy judging other providers will cause you to miss something.

    Then who loses?

    Your patient.
    Exactly. I'll applaud that response.
  6. 0
    Yeah the only blocks atropine is usually used for is mobitz 1 or complete heart block. Wouldn't work for Second degree type 2. Chase I worked as a monitor tech for 12 years before going to nursing school and it really frustrated me when the nurses couldn't accurately interpret their own rhythms. Often I would receive patients from the ER with heart rates in the teens and low 20s where the nurse has reported "sinus brady" when they're clearly in a complete block. Everyone has their specialty and although every patient has a heart, not every nurse is a cardiac one.
  7. 0
    Always nice to meet another EKG nerd OP!

    My vote is for second type II or third degree (or some combination of the two) but there's a reason it's call interpretation, it can be very subjective and unless you're in the electrophysiology lab you may never know for sure. I think when deciding if something is A-flutter it's useful to see if there are distinctive T waves and whether there is a return to the isoelectric line because either of those things suggest something other than flutter. Differentiating the different atrial tachycardias can be helpful when trying to determine etiology and definitive treatment but usually with an acute onset the main concern is rate control so it doesn't really make a big difference and besides, there's always cardioversion!

    We get some interesting interpretations from our monitor techs too: insert rhythm with "minipauses" is my favorite so far.
  8. 0
    An inferior wall or R sided MI isn't an absolute contraindication to using nitro however that being said it these infarcts require adequate preload to support R ventricular function. As long as you don't cause hypotension nitro can be useful but must be used cautiously.
  9. 0
    Thanks for all of the comments. Honestly, A fib w/ 3rd degree never really crossed my mind at the time. It does make sense looking back however I have never seen that before. Very interesting.
  10. 0
    The thing driving me crazy lately- 3x this year- an ER nurse and a 3rd year Resident telling me a patient rhythm was junctional in the 30's to 40's... it was clearly 3rd degree heart block. Actually had a small tiff with the resident until the Cardiology Fellow backed me up


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