ACLS be damned!!!

[JPINFV]

There's no reason I can't see why not. A-flutter is a macro-rentry circuit moving around the tricuspid valve annulus in the right atrium. The other is an AV-node delay. The 2 big questions is just how rare having both would be and would the refractory period of the AV node be slow enough to get the speed down to the 50s.

 

[anestheticmedic]

My medic teacher override paced and got to the ER and the doc pulled the pads off, pulse soared and he quickly put them back on. I wasn't tought it either. That's all I know of it

 

[Aidey]

I would be interested to see A-flutter at 55.

Hmm... A-flutter with 1st degree AV block maybe?

A-Flutter with a 5:1 conduction would be 50bpm wouldn't it?

 

[BluesMedic]

There is a treatment for VT called overdrive pacing. Perhaps this is what Veneficus is refering to. It was taught in the first ACLS class I attended, then when somebody figured out most monitor/defib combos (you know, what people run the first 20min of a cardiac emergency with) weren't capable of performing it, it got dropped.

The basic idea was that you paced the patient at a rate faster than the rate the ectopic foci to gain control of the myocardium. Once your pacer is in control, you slow the rate down to something a little more acceptable to you and the patient.

Keep in mind most EMS pacers won't pace above the rate of your average VT. Also keep in mind I haven't discussed this more deeply than in passing in about 8 years, have never done or seen it, and have never researched whether it actually works or not because it's never been in my scope and I've always had synchronized cardioversion available if I absolutely needed to convert VT. YMMV, taxes and tags are extra, ect, ect.

Hopefully the OP or at least someone who knows more about overdrive pacing will chime in.

I have heard of this also and from what I remember, you are right on how it works. I agree with you and others that it is not used in the pre-hospital setting because of the "normal" monitors we use not being able to pace at that rate.