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 [[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 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: [[Cardizem|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.'''''
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==== 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.

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.