Eydawn Posted March 19, 2012 Posted March 19, 2012 Howdy y'all... For this level of my nursing course, we're dipping our toes ever so gently into the EKG interpretation waters. The "oh shit!" rhythms are no problem... (V-tach, V-fib), PAC's and PVC's are easy to see, counting the little boxes is nice and simple, and we don't have to know any junctional rhythms or blocks just yet. Where I'm getting tripped up is interpreting whether a strip is A-fib or A-flutter, as they appear very similar to me and discussions I've had in the past lead me to believe that some docs use the term interchangeably, as the patient treatment regimen and prognosis don't change much based on which you're seeing. Do you have any suggestions as to how to definitively interpret one from the other on an ECG tracing? At least I wasn't my classmate, who posted up about a totally normal sinus rhythm desperately trying to figure out what was wrong with it... (I wouldn't normally be snarky about a classmate making a mistake, but she's the superachiever who's in it for herself and nobody else, so it was amusing to see her step on her own foot a bit.) ;-) Wendy CO EMT-B
nattlebattle Posted March 19, 2012 Posted March 19, 2012 You should look at regularity. A-fib is irregularly irregular. If you were to use the calipers to measure between complexes they would not match up. 1
Kiwiology Posted March 19, 2012 Posted March 19, 2012 (edited) The nattle is correct; I am so proud (*tear); atrial fibrillation is the only irregular irregular rhythm on the face of the earth (my EEG excluded) I know I'm stating the obvious but atrial fibrillation is caused by multiple ectopic atrial foci whereas atrial flutter is caused by only one ectopic foci Why did I state the obvious you ask? it's not because I like demonstrating my knowledge (seriously, its not) it's because atrial flutter can easily be distinguished if we think of it in terms of where the electrical impulses are coming from; it has polymorphic sawtooth waves (like giant P waves) compared to messed up bizzare fibrillatory waves Atrial flutter is regularly irregular whereas AF is irregularly irregular If you want some of my ECG ebooks you know where to find me (hiding in the corner with a toil foil hat to keep the aliens away and trying to bike lock up my soul because the sermon at church on Sunday was about how Satan wants to steal my soul, wait, does Satan have bolt cutters? poo ... bloody Satan who gave him bolt cutters?) This is atrial fibrillation, notice the polymorphic fibrillatory waves? This is atrial flutter, notice the monomorphic waves? Edited March 19, 2012 by kiwimedic 1
Pavehawk Posted March 19, 2012 Posted March 19, 2012 Spend a little cash on Dale Dubin's EKG book, it's been a mainstay of many a medic/nurse/MD for 30 years. Easy to read, interactive in a semi-workbook way with great mirth to make things fun as well as informative. 2
pcemt Posted March 19, 2012 Posted March 19, 2012 When I was in Paramedic school I had the same issue... I wanted to be able to "glance" and the monitor and KNOW what I had. One of my instructors told me to think of Atrial Flutter as a ribbon flowing, it's pretty and organized. Atrial Fib is just that, a mess. Irregular as all heck. Hope that helps!
ERDoc Posted March 19, 2012 Posted March 19, 2012 atrial fibrillation is the only irregular irregular rhythm on the face of the earth (my EEG excluded) You sure about that, Kiwi?
Eydawn Posted March 19, 2012 Author Posted March 19, 2012 Wouldn't V-fib be irregularly irregular (gosh that double term makes my brains itch)... it's all over the place... Thanks on the Dubin rec, I'll be looking for that for sure by the time we get to the harder stuff... Wendy CO EMT-B
Just Plain Ruff Posted March 19, 2012 Posted March 19, 2012 You sure about that, Kiwi? He did say his EEG was also like Afib too Doc. so he wasn't wrong.
Kiwiology Posted March 19, 2012 Posted March 19, 2012 You sure about that, Kiwi? Of course, for I am Kiwi! ... and you're just a Consultant Physician, the two pale in comparison Love you Doc ... now make with teh kettymainz
ERDoc Posted March 19, 2012 Posted March 19, 2012 LOL. Are you sure there isn't another tachycardic rhythm that is irregularly irregular? No, not afib with rvr. It could be multifocal perhaps.
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