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Sometimes recognizing sinus tachycardia can give us fits. One of the most basic rhythms?
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The discussion that follows will highlight some of the difficulties sinus tach can present at high rates. The pitfalls of using the generalized term "SVT" will also be discussed.
This discussion is not meant to imply that this issue is easy to navigate. It can get very difficult, and very dicey. The consequences of misinterpreting the rhythm and missing sinus tach can have very deleterious effects for our patients. We are all good at recognizing sinus tachycardia at rates betweenbut when rates exceed it seems to become problematic.
Is it difficult to recognize this? When sinus tachycardia occurs at high rates, our ability to correctly differentiate it from other types of SVT apparently decreases.
P waves start to blend into the T waves.
Instead of talking about discreet stand alone P waves, we talk about "notches" and "bumps". We know what sinus tach is: Block down the AV node, and the dysrhythmia terminates.
Quite a bit different from sinus tach. Different mechanisms, different treatments. Several case studies involving the above strips and ones like it have appeared on our FB page, and the FB pages of other EMS educational sites.
What we have seen is that an alarming number of folks incorrectly identify sinus tachycardia as one of the other SVTs and want to treat with Adenosine or cardioversion.
Consider this rhythm strip that appeared on our page and another educational paramedic page: The patient was a sick adult male, hypotensive.
P waves are subtle, but they are there. Here is the followup ECG taken a couple of hours later. The patient was severely dehydrated and had received a few liters of fluid: Now that the rate has slowed, sinus tach is clearly visible.
While we are discussing this, we should be clear about our terminology. Sinus tach is one of the Supraventricular Tachycardias.
They will generally be narrow tachycardias, unless aberrant conduction is present. What are we even taught about SVT? Generally speaking these days, when students are taught SVT they are taught that a narrow tachycardia faster than or is "SVT". How do we differentiate sinus tach from SVT?
If you were taught that, raise your hand. While we are on the subject, where did the rate limit of or come from? There does not seem to be any research I can find that even suggests that these numbers can be used to differentiate ST from other SVTs. In fact, I could not find any research that demonstrates that absolute rate plays any part in differentiating ST from other SVTs.
All I could find is references to the guideline used to determine the theoretical maximum sinus tachycardia in healthy people: It intends to illustrate that very young people can have ST at very high rates, and that as we age, it should be more difficult to achieve higher rates of sinus tach.Oct 23, · ok so im writing this essay about 3 sources of love: unreqited love, friendship love, and romatic love.
im writing this essay after i read romeo and juliet a quote, a Status: Resolved. quotes from All About Love: New Visions: ‘When we face pain in relationships our first response is often to sever bonds rather than to maintain commi.
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