A Fib
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A Fib
Acute Pericarditis
CHF
Complete heart block
HTN
PE
Pericardial tamponade
GOUT
Hypothyroidism
DKA
Urosepsis
About
- A FIB
- Order physical exam
- Results:
- Order 1
- Pulse oximetry, stat
- IV access
- 12 lead EKG, stat
- Results:
- Order 2
- Admit to floor/ward
- Telemetry
- Vitals Q 4 hours
- Pulse oximetry Q4 hours
- Order 'old records'
- Diet: Consistent carbohydrate diet
- Activity: Bed rest with bathroom privileges
- Labs:
- HbA1C, stat
- Accuchecks QID(4 times a day)
- 2D-echo, routine
- Meds:
- Continue all home medications:
- ASA 81mg po qd,
- Simvastatin 20 po qhs,
- lisinopril 5 mg po qd,
- SL NTG prn,
- glyburide 5 mg po QD,
- metformin 850 mg po bid,
- albuterol prn,
- and acetaminophen with codeine for osteoarthritis
- Start Cardizem (diltiazem), IV drip,
- Start Heparin, IV, continuous
- PTT every 6 hours
- Daily CBC with diff
- Call me when lab results available
- Order 3
- Urine culture and sensitivity
- Bactrim PO QD (TMP-SMZ)
- Examine the patient in 2 hours
- After 2 hours
- Interim history
- Monitor telemetry strip: HR is now 90-100/min; patient is still in atrial fibrillation
- Repeat EKG: HR is now 90-100/min; patient is still in atrial fibrillation.
- Call me when needed.
- Examine the patient in next 6 hours
- Again order interim history and monitor telemetry strip
- Once the HR is less than 80
- D/C Cardizem drip
- Start Cardizem PO, continuous
- Next day
- Start Coumadin po continuous
- Daily PT/INR
- Examine next day:
- Check CBC, PT/INR, telemetry strip
- Once the PT/INR is above 2.0, D/C IV heparin
- Discharge the patient
- Patient education
- Out patient followup in 3 days with repeat CBC, PT/INR
- Discussion:
- In unstable patients DC cardioversion
- Rhythm control
- commonly used drugs dofetilide, ibutilide
- left ventricular dysfunction Amiodarone
- maintenance therapy amiodarone or sotalol
- Rate control are beta-blockers, calcium channel blockers, and digoxin
- anticoagulation
- When should I admit a patient with AF?
- Searching for the underlying cause: