Atrial Fibrillation Atrial Flutter

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Section 4 - CARDIAC

4.03 ATRIAL FIBRILLATION / ATRIAL FLUTTER

CONSIDER MEDICAL ETIOLOGY AND REFER TO APPROPRIATE PRACTICE PARAMETER:

STABLE:

  • INITIAL MEDICAL CARE (2.01) - OXYGEN @ 100% via NRB mask or assist with BVM.
  • If rate is greater than 150 beats/minute and narrow complex. Administer DILTIAZEM (CARDIZEM) 0.25 mg/kg IV bolus over 2 minutes if the patient contact and transport time is greater than 25 minutes. If no response in 30 minutes and heart rate greater than 150, DILTIAZEM (CARDIZEM) 0.35 mg/kg IV bolus over 2 minutes
  • If rate greater than 150 beats/minute and wide complex refer to WIDE COMPLEX TACHYCARDIA PARAMETER (4.10)
  • ASPIRIN 81mg, chewed, if not previously administered or with known hypersensitivity to the drug or active ulcer disease.

BLACK BOX WARNING: DILTIAZEM (CARDIZEM) IS CONTRAINDICATED IN HYPOVOLEMIA AND CALCIUM CHANNEL BLOCKER USE. Use in these situations can result in severe bradycardia and refractory hypotension or cardiac arrest.

UNSTABLE:


Physician's Orders: If NO response, contact Medical Control for consult.

This Standing Order is divided between the care and treatment of the stable patient verses the unstable patient. As a matter of definition agreed upon by the Medical Directors, the UNSTABLE patient is one who presents with any of the following: SIGNIFICANT CARDIAC SYMPTOMS, SIGNIFICANT DYSPNEA, ALTERED MENTAL STATUS, OR HYPOTENSION WITH SIGNS OF DECREASED TISSUE PERFUSION, OR SIGNIFICANT COMPROMISE OF AIRWAY, BREATHING AND/OR CIRCULATION.

If there is a prolonged delay or difficulty obtaining synchronization, and the patient is extremely UNSTABLE, then DEFIBRILLATION should be administered.