AMS, hypotensive with HR > 150: Cardiovert?

  EMS was called for middle-aged man, found slumped over a table at restaurant. He had quite a poor mental status and could not offer any medical history. Per the staff he had just arrived, and not eaten or drank anything. Although he is carrying a home glucometer, his blood sugar is 160. He has a new-ish looking hospital wrist band on, but no shoes. Systolic BP in the 80s, and HR around 160.  Dry, hot skin, and the rest of the exam isn’t revealing. IVs are started, and a rhythm strip obtained: And a 12-lead:So, what do we have so far? And what do we do with the ECG findings?   What does the ECG show? Yes, it’s an SVT (supraventricular tachycardia), in the sense that it is not a ventricular rhythm, and the rate is > 100. When we use the term SVT like this, we mean that it could be sinus tachycardia, atrial fibrillation or flutter, MAT, or whatever. All “SVT” means in this sense is “not ventricular tachycardia!” That being said, it is quite regular, so there are basically 3 possibilities: sinus tach, atrial flutter, or PSVT (i.e. AVNRT or AVRT). A heart rate around 150 would be consistent with  atrial flutter, true. But we don’t see flutter waves where we expect to. Instead we see fairly consistent P-waves, correctly oriented. From the rhythm strip we see the P-waves (red arrows) very clearly. But suppose these aren’t P-waves, but instead flutter waves? Then we should find a similar appearing flutter wave exactly ...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: Uncategorized Source Type: research