[mercyme128]

I was hoping to get some info. from some more experienced nurses than myself. I work on a step-down/tele floor, I have only been on my own since September so I am struggling with some of my strips. I had a patient this last week that had been in the hospital for 5 days prior to being assigned to her. She was admitted for A-Fib with RVR. She had been on a Cardizem gtt., Amiodarone gtt., and beta-blockers all with no success. The first night I had there was no change from the 5 days prior according to the strips in the chart and the MT. Heart rate remained 130s to 150s. The next morning the Dr. arrived and looked at the strips. He was furious. He said she had been in SVT all night and wanted to know why he was not contacted. After supervisor reviewed the charts he agreed with me that there was no change since admission. I was hoping to get some input from other nurses out there. I know there is not a p-wave with A-fib, I am just not understanding how the Dr. got that she was in SVT. ??????

[suanna]

The doctor was right A fib with RVR rate 130+ is an SVT but the problem wasn't that the patient was in SVT all night without him being called it was that he had not managed his patient for DAYS! It the drugs aren't working- try different drugs- we have been treating A fib since the middle ages with foxglove tea (digitalis)et al. Surely in an acute are setting letting a patients HR stay above 120 for days in inexcusable on the part of his doctor. If all else fails- cardioversion or H.F ablation could be tried. Without knowing the patient I am hesitant to judge too harshly but it the patients BP was stable, and no acute distress-SOB, change in LOC... You did everything you should have done as a nurse. It's up to the doctor to change the course of treatment if what he has been using is ineffective- and he should have already known that it was ineffective without being called in the middle of the night.

[mercyme128]

Thanks for the reply. I do feal that I did everything that I was supposed to do. I asked the more experienced nurses on the floor for advice and to assess my patient to make sure I was not missing anything. The patient had been treated with dig. as well and her dig level was to high. Thank you for clarifying about SVT though. We had a big debate at work about the difference and everone I asked had a different explanation. Again thanks