Proper term for SVT

[Guest guest]

I'm reposting this portion of Dr. B. 's recent post to the EKG

list.

For those of you who do not know, Dr. is co-author of what I believe

to be the best EKG book on the market now, 12-Lead ECG, The Art of

Interpretation ( and Bartlett).

I fear that many, many EMS services are not providing standard of care in

cardiac cases. I also am becoming more and more aware that the section of the

ACLS course in tachycardias is often neglected, simply because it does require

recognition of different types of superventricular tachycardias. It may well

be that SVTs now warrant a much greater emphasis and amount of time spent than

before.

Here's Dr. 's quote:

" Anyway, SVT is no longer a functional term because it

is an umbrella term. Any tachycardia with the onset

in the supraventricular area (atria and AV node) is

considered an SVT. In the days of the giants, SVT was

used to label what is now known as AVNRT (AV nodal

reentry tachycardia). The reason that we are getting

more specific in labeling and diagnosis is because we

are becoming more focal in our ability to treat the

myriad of SVT's. For example, we now have specific

treatment for recurrent AVNRT. We should not treat

another one of the SVT's by the name of AVRT with

calcium channel blockers, etc. The more specific our

treatment gets, the more accurate our diagnosis has to

be.

I have mentioned it before but as of the 2000

guidelines, you are each responsible to be able to

diagnose each of the individual SVT's. The EMS

community is reluctant to get this through it's head

because I think that a lot of the " older " paramedics

or chief's do not know about these rhythm

disturbances. However, ignorance is no excuse in the

eyes of the law. You are responsible. This brings us

to the next point...when someone places a big red " ? "

[in a QA]

explain that to them and have them contact your legal

department or council for verification.

End of Quote

I would venture the guess that a majority of the paramedics now on the

streets are not able to differientiate between different types of SVTs.

What Paramedics are expected to know about cardiology is light years ahead of

what I was taught in my paramedic course in 1981. Twelve-leads were

something that none of us thought we would ever need to learn. Now, 12-lead is

standard of care.

Remember that lawyers can buy books the same as doctors and other medical

professionals, and most of the plaintiff's lawyers have them. They also lurk on

lists. When textbook authors talk about standard of care, they listen. When

ACLS recommends something, the presumption is that it's SOC. I know some

foolish doctors who believe that they'll convince a jury that ACLS is only a

guideline (which it is). But a few simple questions can make it a guideline

that

you fail to follow at your peril.

Q: So, doctor, you're telling this jury that you choose not to follow the

American Heart Association's guidelines. Is that right?

Q: Doctor, have you conducted any independent peer reviewed research studies

that support your theory of treatment being different from the AHA?

Q: Doctor, let me show you this copy of the 2003 ACLS Textbook. You've seen

that, have you not?

Q: Look on the first page, doctor, if you would be so kind, and tell me how

you have arrived at a different judgment in emergency cardiac care from the 27

medical doctors whose names are on that page as authors or contributors to

that textbook.

Now, imagine similar questions being asked to you, a Paramedic. Get the

picture?

Quiz: How does treatment for an MI involving the RV differ from standard

MONA?

If you do not know the answer to this question, my advice is to put a good

attorney on retainer before you make your next call. Or better still, do some

research and find the answer.

Mr. Grady

Evil twin of G.G.