Atrial fibrillation, particularly A-Fib with RVR (Rapid Ventricular Response), is often an emergency requiring emergent intervention beyond ACLS and its associated algorithms. Identification of A-Fib can be challenging in itself, much less trying to determine what intervention(s) are indicated. This includes chemical and/or electrical cardioversion. So where do we start? And where should we end up? Dan and Mike will let you know in this podcast episode.
The Down and Dirty
- Get a 12-lead EKG. Slow down the paper if the rate is fast.
- Determine if the patient is sick because they have A-Fib, or they have A-Fib because they’re sick. (More often they have A-Fib because they’re sick.)
- Treat the underlying cause.
- Treat with anti-arrhythmics, calcium channel blockers, beta blockers, magnesium, and/or all the above. (Amiodarone is usually the first-line choice.)
- Proceed to electrical cardioversion for instability. Shock higher, shock less. (Make sure you pre-treat.)
In general, come up with ways that are efficase, safe, and you are most familiar with. Become familiar with the drugs you’re going to use most frequently and use those drugs when it’s appropriate most frequently.
For another podcast episode on tachy arrhythmias, check out Episode 62 – Fast Rhythms, Furious Management w/Dr. Salim Rezaie (Bonus Feature)!
Wolff-Parkinson-White Syndrome/Delta Wave