Quote from missnurse01
We often have cardiologists not know exactly what many funky rhythms are, and most only care if they have a b/p. If vent rate is high sometimes they give meds to slow it down to diagnose, but no one seems to treat differently
I would have to agree here, for sure. If we are talking about indistinguishable fast rhythms, most cardiologists are not so interested in the strip that they really care exactly what every 6 second strip indicates (because some folks' rhythms change that frequently). They mostly care if the patient is symptomatic (low BP, diaphoretic, chest pain, dizzy) or not.
Unknown fast rhythms here would get amio/cardizem/metoprolol/combo of these. Unless the pt is obviously symptomatic then you go with Adenosine. Period. Once you get the rhythm slow enough to distinguish it, more specific treatment can begin. If you can't get the rate down with all these meds and the pt is having chest pain and is SOB and diaphoretic, what do you do? Whats that red cart over there for?
Remember that Atrial Tach and SVT (supraventricular meaning above the ventricle...isn't the atrium up there?) are extremely similar and are thus treated similarly. Atrial flutter is just a few atrial spasms away from atrial fibrillation, and the two rythms are treated nearly the same.
Now, if you have a pt that truly has atrial tach with a 3:2 block, for example, the pt most likely has some dig toxicity. You probably won't see this rhythm too much (good to know, but, for most practices, not widely diagnosed) bc dig levels are checked often in the hospital for pts on dig and Digibind is quickly given if labs are critical, but this is also fairly rare.
If the pt is on digoxin (without a recent lab level) and is having atrial tach with block (without PMHx atrial flutter, so not to confuse things), you will be able to proudly notify the cardiologist and give your SBARecommendation of a dig level, renal panal, mag and then perhaps Digibind.
Keep on learning 'yall!