Any Difference?

Editorial Team / Admin · Sep 8, 2005

The education consultants from our state BON actually suggested we only teach NSR and the lethal dysrhythmias (asystole, PEA, v-tach, v-fib) and leave it at that :uhoh21: We decided not to follow this advice - We felt our students need much better preparation in ECG, since most med-surg floors have patients on telemetry. Many of our students also directly go to ICU floors and step downs as new grads.

Oh, my, I agree. That is one thing that happens. The BON says one thing and then when out of school reality sets in and these nurses do not know how to recognize these arrhy/dysrhymias. You are doing great..... :balloons:

I have the ACLS EP on power point. If you are interested, I can try to email them to you..... :)

VickyRN, MSN, DNP, RN · Sep 8, 2005

Oh, my, I agree. That is one thing that happens. The BON says one thing and then when out of school reality sets in and these nurses do not know how to recognize these arrhy/dysrhymias. You are doing great..... :balloons:
I have the ACLS EP on power point. If you are interested, I can try to email them to you..... :)

Thanks, Siri so much. I sent you a PM :)

papawjohn · Sep 8, 2005

Hey Y'all

I find I've sorta come full circle and am dealing with cardiac again so maybe I'm out of date. But it seems to me that the critical question in dealing with atrial/junctional tachicardias is whether the atria have a chance to fill. There are all kinds of interesting rhythm strips out there we can obsess over. (My favorite is AFib v Multifocal Atrial Tach v Sinus Tach w/ multifocal PACs: "See! That p is just like that p...there it is again!")

At our leisure, its a wonderful way to spend quiet hours. At the bedside, (Sunday morning, 0200, do you wake up the Doc?)--not much difference.

If I were teaching in school--I don't think I'd spend much of my students mental energy learning the deeper intricacies of conduction and lead placement and such. I'd focus on stroke volume--which mostly involves atrial filling & packing, and rate control.

My $.02 worth.

Papaw John

SEOBowhntr · Sep 9, 2005

I have a couple $.02 to throw in too. I will start by saying that Atrial Tach and SVT are in the same classification, however, a true atrial tach, will not break with the administration of Adenosine, only slow slightly if at all and continue due to where the re-entry pathway is, while a SVT below the SA node will occasionally break with Adenosine. But in the overall realm of things, John has the major factor covered here, what is the SV??? and what is the patient's cardiac output like??? Are they symptomatic???

I dealt with one last night who was in A-fib with a rate all the way up into the 160's, but it was obviously A-fib, irregular, with no identifiable P-waves, however, my first reccommendation was to correct her hypoxia issues while waiting on the Dr. to call back. Atrial arrhythmias will go hand in hand with acute hypoxia. In this patient's circumstance, she was multiple medical problems including COPD (severe), low LVEF (approx 15%), recent CABG, and Pneumonia. A combination of some correction of her hypoxia and rate control with the use of Cardizem settled her down and without any adjustment of her O2, which was at 50%, pre Cardizem her PAO2 went from a 47% to a 60%, just by decreasing her HR and in the long run, decreasing her Cardiac O2 demand. Her BP also improved slightly 10-15 mm Hg, even though she'd been started on Cardizem which could have potentially caused some vasodilation, the decrease in her rate 50-60bpm actually did more to improve the hemodynamic status and blood pressure than the mild vasodilation could counter.

The Job is fun when we get to take one and pull him/her from the grasp of death and say "Not today."

Dinith88 · Sep 11, 2005

I have a couple $.02 to throw in too. I will start by saying that Atrial Tach and SVT are in the same classification, however, a true atrial tach, will not break with the administration of Adenosine, only slow slightly if at all and continue due to where the re-entry pathway is, while a SVT below the SA node will occasionally break with Adenosine. But in the overall ."

Thats actually a little mixed-up. A 'true' atrial tach can surely be broken by adenosine beacuse it 's CAUSED by a re-entrant pathway. (Adenosine induces asystole long enough for the SA node to 'jump-start' itself and 're-claim' the heart from the 'short circuit'. This is exactly why it WONT work in afib. You cant stop an sa-node from firing if it's not firing anyway (atrial-myocardium captured by chaotic electro-static in a-fb..not organized SAnode-impulse), etc...