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Maybe I just get passed the difficult ones that the SHOs fail on, then. I do get some to revert, as I say, but I don't seem to have a great success. I think (and hope) my cardiology colleagues would take me aside if I couldn't tell AF from SVT! Remember many patients attend with multiple episodes, and tend to know themselves that they have reentrant pathways or whatever. A lot of reentrants are resistant. > Hang on a minute, if you're using up to 24 mg of adenosine, but > failing, in > 70% of your "SVT" patients, then I suggest that you're trying to convert > something other than SVT! If the patients are "flatlining" then it > can't be > a ventricular rhythm, but it could be A-flutter or A-fib. A-flutter is > very > similar to SVT on ECG, and fast A-fib will appear "regular" on ECG as > it's > so difficult to detect minor degrees of irregularity in rates faster > than > 160-180 bpm. > > Adrian Fogarty > Best wishes, Rowley Cottingham [log in to unmask] Visit the new and improved http://www.emergencyunit.com