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How to Diagnose Atrial Fibrillation

Atrial fibrillation is the most common arrhythmia encountered in clinical practice. Misdiagnosis of atrial fibrillation carries significant implications for patients.
Fibrillation of the atria may result in a chaotic disturbance of the isoelectric line, however, this finding on an ECG can be misleading as muscular activity or agitation can cause a similar appearance.
Ask yourself is the underlying pattern of R waves truly chaotic. If there is any pattern in the occurrence of the R waves, regular or regularly irregular, then fibrillating atria are not driving ventricular depolarisation. It can be more difficult than you might think to be sure of this.

Look for QRS grouping.

Approximately 20% of cases labelled atrial fibrillation are incorrectly interpreted and up to half of these cases are not corrected by the doctor reading the ECG! 



Why EMS Should Limit the Use of Rigid Cervical Collars

Over the last few years we've seen significant changes in the prehospital treatment of patients with potential spinal injuries. We've quickly gone from using rather extensive spinal mobilization techniques to doing virtually nothing. Few of the recent advancements in EMS have been this significant. As a result, these changes have caused considerable angst among both prehospital providers and hospital-based personnel.
Journal of Emergency Medical Services

The Evidence Against Backboards

Rarely does a day go by when we don't learn of an EMS system that has abandoned backboards and the older archaic practices of prehospital spinal immobilization. This trend began initially in North Carolina and later in California. Now, most of the progressive EMS systems have discarded or changed their spinal immobilization practices. They've replaced these with various strategies that minimize backboard use.  

EMS World