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... Read More
Aug 19, '12Always 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.
Aug 19, '12An 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.
Aug 19, '12Thanks 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.
Sep 27, '12The 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