Atrial Fibrillation Atrial Flutter: Difference between revisions

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==== STABLE: ====
==== STABLE: ====
* [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - [[Medical Gases|OXYGEN]] @ 100% via NRB mask or assist with BVM.
* [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - [[Oxygen|OXYGEN]] @ 100% via NRB mask or assist with BVM.
* If rate is greater than 150 beats/minute and narrow complex. Administer [[Antiarrhythmics|DILTIAZEM (CARDIZEM)]] 0.25 mg/kg IV bolus over 2 minutes. If no response in 30 minutes and heart rate greater than 150, [[Antiarrhythmics|DILTIAZEM (CARDIZEM)]] 0.35 mg/kg IV bolus over 2 minutes
* If rate is greater than 150 beats/minute and narrow complex. Administer [[Cardizem|DILTIAZEM (CARDIZEM)]] 0.25 mg/kg IV bolus over 2 minutes. If no response in 30 minutes and heart rate greater than 150, [[Cardizem|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 Uncertain Origin|WIDE COMPLEX TACHYCARDIA PARAMETER]] (4.10)
* If rate greater than 150 beats/minute and wide complex refer to [[Wide Complex Tachycardia Uncertain Origin|WIDE COMPLEX TACHYCARDIA PARAMETER]] (4.10)
* [[Salicylates|ASPIRIN]] 81mg, chewed, if not previously administered or with known hypersensitivity to the drug or active ulcer disease.
* [[Aspirin|ASPIRIN]] 81mg, chewed, if not previously administered or with known hypersensitivity to the drug or active ulcer disease.


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


==== UNSTABLE: ====
==== UNSTABLE: ====
* [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01)- [[Medical Gases|OXYGEN]] @ 100% via NRB mask or assist with BVM.
* [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01)- [[Oxygen|OXYGEN]] @ 100% via NRB mask or assist with BVM.
*O2 saturation, monitor in place.
*O2 saturation, monitor in place.
* [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 50 Joules.
* [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 50 Joules.
*Consider pre-medication with [[Sedative Hypnotics|MIDAZOLAM (VERSED)]]. Start at 2-5 mg then 2 mg every 30 seconds to 1 min IVP or IN if patient is conscious.
*Consider pre-medication with [[Versed|MIDAZOLAM (VERSED)]]. Start at 2-5 mg then 2 mg every 30 seconds to 1 min IVP or IN if patient is conscious.
*May repeat as necessary to allow for sedation. See [[Analgesia and Sedation|ANALGESIA/SEDATION PARAMETER]] (2.04)
*May repeat as necessary to allow for sedation. See [[Analgesia and Sedation|ANALGESIA/SEDATION PARAMETER]] (2.04)
* If NO response, [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 100 Joules.
* If NO response, [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 100 Joules.

Latest revision as of 14:45, 24 April 2020

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 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.