Re: SVT vs Atrial Flutter

Originally Posted by ele4life

yea. a 12 lead ekg is great. but if in case you don't have the time to wait around for one and if you're losing bp because of no preload. a quick way to check is with adenosine. done correctly you'll either see the flutter or stop the SVT... Hope this helps!

Good point-it the pt is crashing who cares what the fast rhythm is called. As long as you can differentiate between a wide QRS and a narrow QRS, you can treat the patient...

...Now, what about that nasty BBB? (I love to muck things up )

Re: SVT vs Atrial Flutter

Hm.
Well I don't entirely agree. I have seen irregular atrial flutter before.
And a rapid atrial fib/flutter (where they go in and out of both) can come across your screen at 200bpm looking like flutter.... or SVT.... sometimes you just love your patients.

I always slow the paper speed down (and then change it so you don't give the next nurse a heart attack) and then you can clearly see what you are looking at!

as usual, the best is an EKG, or a trial dose of adenosine (it's kinda a diagnostic medication) that i've seen some docs use to slow it down long enough to see whats going on... of course it's acls, so depending on the hospital a decompensating patient will get it without an order anyhow. .... if not for that pesky "prolonged asystole" they warn about on the box it's a great drug.

Re: SVT vs Atrial Flutter

AVNRT is the most common variant of SVT. AF and flutter are technically SVTs but the common parlance of SVT refers to AVNRT, atrioventricular tachycardia (accessory pathway), and atrial tachycardia.

AVNRT will not always show a PA wave- it may be before, buried, or after the QRS.

SVT is more likely to be regular.

For an equivocal ECG, adenosine is the best way to differentiate the two- it will block AVN conduction, and as the R-R widens you will see flutter waves or not.

If a pt is hypotensive and in a narrow complex tachyarrhythmia, don't use adenosine; sync cardiovert.

Another option is available if you have atrial temporary pacing wires, which is an atrial ECG (attach the pacer wires to alligator clips on the ECG machine, or touch them to the chest leads). It will show large amplitude narrow complexes where the atrial activity is. (I know this is not your test, but good to have in the back of your head).....

Re: SVT vs Atrial Flutter

Man, it's a long time since I did an atrial ECG - I *loved* doing them when unsure of the rhythm. Nowadays most of my patients don't have routine atrial wires postop though.

Re: SVT vs Atrial Flutter

I do them occasionally and the unit RNs look at me like I'm crazy. They do not teach this skill at my place.....

Re: SVT vs Atrial Flutter

Originally Posted by Misty1

ARGH!!!!!!!! Correct answer : Do an EKG. That was in my answer seems like sometimes we make things harder then they have to be.

That was my initial thought. And this is why I don't like these types of test questions. SVT vs AF are rhythms that CANNOT be answered with only 1 or 2 leads especially if the rate is very high. Yes a slower paper speed can help I guess. But a better answer than ANY of them is: GO LOOK AT THE PATIENT! Doesn't matter what the rhythm is if your patient is circling the drain. When I help my students with rhythm strips I give them clear rhythms to interpret, nothing wishy-washy. If seasoned nurses like me have occasional difficulty with interpretation, how can we expect students to do it for a test?

Just my