AFIB with RVR and wide complex??

[Alan L Serve]

Just to stir the pot a little more on using adenosine diagnostically, Heart & Stroke Foundation in the Pediatric Advanced Life Support (PALS) manual (2011 edition) on p.130 it state under Indications:

"May be helpful in disgtinguishing atrial flutter from SVT"

The Heart & Stroke also say in their Advanced Cardiac Life Support (ACLS) manual (2016 edition) for Wide Complex Tachycardias:

"If the rhythm etiology cannot be determined and is regular in its rate and monomorphic recent evidence suggests that IV adenosine is relatively safe for both treatment and diagnosis" p.145


**also, I'm still looking for clarification on whether this is considered a narrow or wide QRS complex. (Sorry for the newb question - I'm a new EMT and having a bit of difficulty determining where we consider the isostatic baseline to be with the rhythm the OP posted) - that is, if what I'm seeing is a delta-wave or T-wave.

The rhythm posted surely was not regular. It had very clear Afib as demonstrated by the goofy-looking p-waves but also a polymorphic characteristic of the narrow QRS complexes.

Those who advocate for using Adenosine when it's so clearly absolutely contraindicated....gulp.

 

[NomadicMedic]

Pretty clearly afib.

 

[Alan L Serve]

View attachment 3414

Pretty clearly afib.

Hard to see how anyone could interpret it otherwise or why they would ever use Adenosine or even consider the use of Adenosine for diagnostic purposes. The dx is super obvious. Fast rate + Afib = rate control and pressure support. Let them synch cardiovert in the ED.

 

[BassoonEMT]

Two year old threads are the BEST threads!


I always took "adenosine as a diagnostic tool" to be more of a well known backup plan.

By that I mean "well this looks like SVT, lets give the adenosine". Heart slows, revealing a rhythm with no p waves, and more irregular than originally seen, and then tachs up again. The adenosine wasn't the resolving treatment, but you've now used it to diagnose that the rhythm is a-fib, and can treat accordingly.
But maybe that's just me.

But yes this was definitely a-fib from the start.