What do you mean? How would you note that electrical activity on the ecg? Do you mean the occasional blip or complex?
I was asking that question since we're assuming p-wave fibrillation can be so fine that it was indistinguishable from a flat isoeletric line.
Either way, wouldn't be distinguishable in the field and neither would really alter my course of treatment.
Although it probably wouldn't change our treatment prehospitally, it's an interesting discussion, and it would be nice if an admin can separate this if you, Clare, and Chase don't mind.
What I meant was constant electrical activity with low amplitudes. I believe that ventricular fibrillation can become so fine that people may call it asystole, but with treatment, changed monitor settings, or a 12-lead, you may see fibrillation waves.
This made me think about ACLS, and I kinda want to read the experience provider book to see if the answer is in there. It's obvious why we don't defibrillate asystole, but what if the fibrillation waves in fine ventricular fibrillation are so small that we call it asystole, or it's indistinguishable? If that's the case, the patient has probably been down for a long time. I imagine that it would be unlikely that they would respond to defibrillation for many reasons like hypoxia and the right ventricle being fluid overloaded, but would respond to chest compressions and epinephrine. Isn't asystole usually associated with somebody dead dead? I don't think epinephrine would create electricity for it to become a shockable rhythm. I just thought this was pretty interesting to think about since the AHA does pull stunts like this and try to consider provider errors in their algorithms.
Atrial fibrillation can be tricky sometimes. It can have fibrillation waves so small that it does look like a flat isoelectric line. It can look regularly regular if the patient is taking digoxin, or the fibrillation waves can be so course that it looks like atrial flutter (with a variable block).
When I interpret rhythms or 12-leads, I am not always 100% sure what it is, but I'll say what I think is most likely. I would be more comfortable if we had a longer rhythm strip and/or a 12-lead, but since we don't have that, based on the strip we do have, I think atrial fibrillation is most likely.
First, atrial fibrillation is the second most common supraventricular tachycardia. Probability is already on our side!
It's irregularly irregular without discernible p-waves, which fits atrial fibrillation best.
It's also fast which I think favors atrial fibrillation.
I am assuming that people are calling the fourth and seventh complex a premature contraction, which is something I considered though. It's late though... It would really be an escape beat instead. It also does not have a compensatory pause which makes it being a premature contraction less likely.