David B writes –
I have on several occasions thought it would be nice to have a button to press (i.e. the 4:1 button during pacing) that would run the printer at double speed for about 6 seconds, then revert back to normal. An opportunity to perhaps see more clearly, yet reverting back to standard speed to avoid pitfalls of changing printer speeds.
An excellent idea for a way to improve the amount of information available and avoid complications of inadvertently leaving the monitor in Slow Motion mode.
I don’t really see the benefit in pacing. I think that the emphasis with pacing should be on physical assessment of the change in presentation, to help determine if there is capture.
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Prehospital RN writes –
Even in the hospital, it always amazes me how often people want to try to “fix” sinus tachycardia with antiarrhythmic medications
Should an arrhythmia be treated with an antiarrhythmic medication if the medication is supposed to break the rhythm?
Where is the benefit from getting rid of sinus activity?
I stopped the sinus node from conducting to the ventricles. Yippee!
Iatrogenic third degree block, or an iatrogenic junctional rhythm, or an iatrogenic ventricular rhythm, is not what we should be trying to cause.
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just yesterday I was reading in a patient’s earlier nursing notes that he was “found to be in sinus tachycardia with a rate in the 160′s” and was subsequently given diltiazem and, when that didn’t work, a full 3 doses of adenosine.
That is a great case to point out some of the problems with the reasoning behind using antiarrhythmic medication for a problem that is only expected to get worse with antiarrhythmic medications.
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This particular patient was pretty sick and had multiple underlying factors that could be contributing to the tachycardia, including sepsis and a PE, but instead everyone wants to jump right to fixing his heart rate. I see this way more often than I should . . .
Seeing this one time is seeing this too often.
There is no reputable organization that recommends treating sinus tachycardia with antiarrhythmic medication. Not the AHA (American Heart Association), which writes the ACLS and PALS (Advanced Cardiac Life Support and Pediatric Advanced Life Support) guidelines.
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On the other hand, I did once give adenosine to a patient with a heart rate in the 120′s (after consultation with the patient’s cardiologist, as the patient was stable). Previously, the rhythm had been documented as “sinus tachycardia” simply because of the rate and the fact that it was regular … but on reviewing this patient’s 12-lead EKG there were no visible P waves, and the rhythm had absolutely no R-R variability. I showed the EKG to the cardiologist, who identified it as a type of SVT. Vagal maneuvers were unsuccessful, but the pt converted to a normal sinus rhythm in the 70s following 6 mg of adenosine.
SVT (SupraVentricular Tachycardia) in the 120s?
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Clearly, the patient has not been following the formula for calculating the maximum rate for sinus tachycardia, which would be presumed to be about the minimum rate for SVT. Or is the patient in his 90s?
No P Waves? This could be due to the lead being used. Laeds II and V1 (or MCL1)are usually the best leads for looking at P Waves. This could also be due to the axis of the sinus activity.
Without P Waves it might also be V Tach (Ventricular Tachycardia), even with narrow QRS Complexes.
Regular must be sinus?
Regular is more often associated with SVT or V Tach, but we find ways to convince ourselves that we are looking at whatever our initial impression suggested. If this information comes from dispatch prior to our arrival on scene, it can be very difficult to ignore this prejudicial information.
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Which just goes to show … rate is only a very rough guideline, and if you allow yourself to be distracted by it you might miss something important.
And we might do something very dangerous.
Assessment of rhythm requires more than just one step and a leap to a conclusion. We should consider all of the information on the ECG, rather than decide to ignore some of the ECG information.
Rate is important, but only when looked at in the context of the entire patient presentation.
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The patient I referred to in my previous comment with the heart rate in the 120’s had a type of SVT known as “slow-slow (atypical) atrioventricular nodal reentrant tachycardia” (AVNRT) and had an EKG very similar to this one:
http://crashingpatient.com/wp-content/images/part4/AVNRT-Arrival-Small1.jpg
Hi i have SVT i have had it for a long time and i am 16 now i just want to know will i
Ever grow out of it