CLINICAL MANAGEMENT GUIDELINE

Atrial fibrillation

ICD10: Unspecified atrial fibrillation and atrial flutter [I48.9]

Treatment: Acute Afib w/ hypotension; DBP < 60

Identified as electrical chaos; it is a from of unpatterned depolarization of atrial tissues caused by multiple micro reentry circuits.

ECG findings: absent P waves, fibrillatory waves, and irregularly irregular QRS complexes.

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May manifests as palpitations, dyspnoea, angina, dizziness, syncope, and/or features of congestive heart failure, stroke, and death.

Risk factors:

  • Coronary artery disease.

  • Cardiac hypertrophy.

  • Rheumatic heart disease.

Refernce


Characterized as decrease level of consciousness , low blood pressure; DBP< 60 , acute cardiac chest pain, and/or signs of acute heart failure.

Success criteria: 1

  1. Retain sinus rhythm.
  2. Correct BP.
  3. Establish baseline tests.

Follow sequence: 1

  • 1st. Start anticoagulation plan, if unknown onset.
  • 2nd. Start with sedating the patient.
  • 3ed. Perform DC cardioversion.

If failed,

  • 4th. Retain BP through vasopressors and HR control.

Treatments

Level 1 / 2
pharmacological
Propofol
ROUTE
IV
DOSE
20.000 mg
FREQUENCY
STAT
pharmacological
Morphine
ROUTE
IV
DOSE
5.000 mg
FREQUENCY
STAT
pharmacological
Midazolam
ROUTE
IV
DOSE
1.000 mg
FREQUENCY
STAT
consultation
Prescription of therapeutic regimen
consultation
Prescription of therapeutic regimen
procedures
Transoesophageal echocardiography
procedures
Direct current cardioversion

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