• Rapid succession of identical consecutive atrial depolarization waves. The p-wave will have a distinctive SAWTOOTH appearance.
• You’ll typically see two or three of these saw tooth morphologies between each QRS complex. If you see one that is clear and distinct, and you don’t see a second, it might be obscured by the t-wave. 
• It is either a reentrant impulse, or an irritable automaticity focus that will fire, causing a bpm of 250 to 350. The refractory period of the AV node will allow one in every two or three impulses to propagate to the ventricles. 
• The causes of atrial flutter are similar to the multifocal atrial tachycardia, and atrial fibrillation where we’ve got the main forms of heart disease, and COPD and other hypoxic pulmonary conditions being the contributors. If I had to guess this might be due to the rest of the body realizing a requirement for increased oxygen and signaling for an increase in heart rate.
• The treatment for atrial flutter include:
  • Ablation, where scar tissue is created to prevent the over-firing of the atrial focus. This treatment is highly successful, and the main course of treatment in Step-Up and First Aid.
  • If ablation is not available Step-Up says to follow atrial fibrillation protocol for treatment:
    • If the patient is not hemodynamically stable, cardioversion is the best option, which is when you shock the heart in synchrony with the QRS complex(As opposed to defibrillation which is shocking the heart asynchronous to the QRS complex). Patients will also require anticoagulation after cardioversion, they’ll also require a transesophageal echo.
    • If the patient is hemodynamically stable, then control the rate with beta-blockers. CCBs can be used as an alternative if the patient doesn’t have heart failure with reduced ejection fraction. Also, as long as the patient is not at risk for bleeding complications, use anticoagulants to reduce the possibility of forming an embolism

Information taken from Step-Up to medicine 5th edition and First Aid 2022