1:1 Flutter?

During a night shift Cole and I were sent to a 61 year old female, who had activated her medical alarm.

The patient was in bed complaining of not being able to get out of bed as her knees felt weak and woozy. The patient also stated that she had a previous episode of weakness the night before and ended up fallen on the floor.

Pt stated that she had ablation on Friday the 9th which was her 2nd, which failed then the patient had a  pacemaker inserted which ended up as haemotomina and had to be removed on the Saturday and the patient was discharged on the Monday and stated she didn’t feel like she should of be discharged.

Pt radial felt regular and strong at the radial with Hr of 64 speaking full sentences and skin colour normal and Bp of 105/50 which the patient stated as being normal for her.

Due to the patients lack of mobility we recommended transport but the patient refused, we asked the patient to stand and which she was able to do on her second attempt, and took her bp which was record at 85/45 confirmed with a manual. The patient  continued to refuse transport and keeped telling us that it is normal for her to have a low bp. The patient then asked us to preform a ecg and said that if that was abnormal she would come with us.

The original 3 lead should a flutter and a heart rate of 70, this soon changed into this

1st 3 lead
12 lead

The pads were applied and iv insert with r50 called and on it’s way.

The patients vitals were:

GCS 15

HR 300

Bp 90/50

RR 20 Spo2 100% and speaking full sentenices

Patient was slightly pale, non sweating

pt remained in this rhythm for roughly two mintues and just as the R50 turned up reverted as we were moving her to the carry chair.

Reverted 12 lead

I believed that the patient was moderately compromised and that the ecg rhythm was a atrial flutter with a 1:1 conduction .

Pt was discharged later that day, with nil abnormalities detected and the patient didn’t go back into the rhythm while in ed. the plan for the patient was for her to have a stress test and tilt table to try and see if they can get the rhythm to happen again…..



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