Atrial Fibrillation/Flutter Management
71 Questions
1 Views

Atrial Fibrillation/Flutter Management

Created by
@AmenableFriendship5284

Podcast Beta

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the defined ventricular rate for rapid atrial fibrillation and atrial flutter?

  • Greater than 150 beats per minute (correct)
  • Less than 100 beats per minute
  • Between 100 and 150 beats per minute
  • Exactly 150 beats per minute

    • Which is a contraindication for administering CARDIZEM?

  • Heart failure
  • High blood pressure
  • Tachycardia
  • Hypotension (BP less than 90) (correct)

    • What is the first step in treating an unstable patient with a systolic BP less than 90 mmHg and/or altered mental status?

  • Administer CARDIZEM 10 mg IV
  • Administer 1L of normal saline IV (correct)
  • Perform immediate CPR
  • Cardiovert if unstable

    • What must be considered when using CARDIZEM with caution?

    <p>Patients taking beta blockers</p> Signup and view all the answers

    How is Push-Dose Pressor Epi 1:100,000 prepared?

    <p>By discarding 9 mL of Epi 1:10,000 and adding 9 mL normal saline</p> Signup and view all the answers

    What is the maximum total dose for Push-Dose Pressor Epinephrine administration?

    <p>0.2 mg</p> Signup and view all the answers

    Which condition is a contraindication for the use of Atropine?

    <p>Bradycardia with an MI</p> Signup and view all the answers

    What is the initial rate for transcutaneous pacing?

    <p>80 beats per minute</p> Signup and view all the answers

    What is the maximum single dose of Versed when given IV/IO for sedation during transcutaneous pacing?

    <p>5 mg</p> Signup and view all the answers

    What is the recommended dilution method for creating Push-Dose Pressor Epi 1:100,000?

    <p>Discard 9 mL of Epi 1:10,000 and add 9 mL Normal Saline</p> Signup and view all the answers

    What should be monitored during the administration of Push-Dose Pressor Epinephrine?

    <p>Heart rate and blood pressure</p> Signup and view all the answers

    What is the effect duration for Push-Dose Pressor Epinephrine after administration?

    <p>5-10 minutes</p> Signup and view all the answers

    Which intervention should NOT be delayed even if IV access is not established when pacing?

    <p>Transcutaneous pacing</p> Signup and view all the answers

    What respiratory action is recommended for infants and children in response to bradycardia?

    <p>1 breath every 3 seconds for 1 minute</p> Signup and view all the answers

    What should be the first step taken for a pediatric patient experiencing bradycardia?

    <p>Ensure adequate oxygenation</p> Signup and view all the answers

    Which symptom indicates that a bradycardic patient is unstable?

    <p>Systolic BP under 90 mmHg</p> Signup and view all the answers

    How often can Atropine be repeated for treating bradycardia?

    <p>Every 3 minutes</p> Signup and view all the answers

    What is the initial medication to consider for a patient with cardiogenic shock?

    <p>Push-Dose Pressor Epinephrine</p> Signup and view all the answers

    What is the maximum total dose of Push-Dose Pressor Epinephrine that can be administered?

    <p>20 mL</p> Signup and view all the answers

    In the case of hypotension secondary to blood loss, what is the primary contraindication for administering Push-Dose Pressor Epinephrine?

    <p>Hypotension secondary to blood loss</p> Signup and view all the answers

    At what rate should Push-Dose Pressor Epinephrine be administered?

    <p>1 mL/minute</p> Signup and view all the answers

    What precaution should be taken when administering Normal Saline in a patient with significant coronary heart disease?

    <p>Be cautious and monitor closely</p> Signup and view all the answers

    What is the recommended dose of Fentanyl for adult patients experiencing chest pain?

    <p>100 mcg</p> Signup and view all the answers

    What is the function of Normal Saline in patients who remain hypotensive after fluid administration?

    <p>Increases blood pressure</p> Signup and view all the answers

    What is the indication for a V4R assessment?

    <p>ST segment elevation in two or more Inferior leads</p> Signup and view all the answers

    What should be done if a patient still reports pain after the maximum administration of Fentanyl?

    <p>Use Nitroglycerin</p> Signup and view all the answers

    What is the max dosage of Normal Saline that can be administered to pediatric patients experiencing hypotension?

    <p>20 mL/kg</p> Signup and view all the answers

    Which of the following conditions may mimic a STEMI according to the protocol?

    <p>Pericarditis</p> Signup and view all the answers

    What morphology indicates a potential STEMI during ECG assessment?

    <p>Convex or straight morphologies</p> Signup and view all the answers

    What is the effect of Push-Dose Pressor Epinephrine?

    <p>Rapid onset with short duration</p> Signup and view all the answers

    According to Sgarbossa Criteria, which of the following represents discordance?

    <p>ST and T waves in opposite direction to QRS</p> Signup and view all the answers

    What is a sign or symptom commonly associated with pulmonary edema?

    <p>Hypertension</p> Signup and view all the answers

    Which of the following medications can be administered SL as long as BP is over 90 mmHg?

    <p>Nitroglycerin</p> Signup and view all the answers

    What should you do if pulmonary edema and hypotension are present?

    <p>Follow the Cardiogenic Shock Protocol</p> Signup and view all the answers

    Which of the following is a contraindication for administering Adenosine?

    <p>Previous heart transplant</p> Signup and view all the answers

    In pediatric cases, what is the maximum dose of Adenosine for SVT that can be administered?

    <p>12 mg</p> Signup and view all the answers

    What is the normal saline dosage for treating Cardizem induced hypotension?

    <p>1 L IV/IO</p> Signup and view all the answers

    Which of the following conditions does NOT contraindicate the use of Nitroglycerin?

    <p>History of ischemic stroke</p> Signup and view all the answers

    What is the typical heart rate cutoff for diagnosing SVT in pediatrics?

    <blockquote> <p>180 beats per minute</p> </blockquote> Signup and view all the answers

    Which of the following is an appropriate intervention for an unstable patient with hypotension and AMS?

    <p>Perform synchronized cardioversion</p> Signup and view all the answers

    Which medication is used as a first line treatment for Supraventricular Tachycardia (SVT)?

    <p>Adenosine</p> Signup and view all the answers

    What should be monitored frequently in all patients receiving treatment for SVT?

    <p>Lung sounds and BP</p> Signup and view all the answers

    Which of the following statements about Vagally maneuvers is true?

    <p>They have no effect on SVT</p> Signup and view all the answers

    What is the maximum dose of Versed that can be used for sedation in adults?

    <p>10 mg</p> Signup and view all the answers

    What is a notable precaution when using Cardizem?

    <p>May cause hypotension</p> Signup and view all the answers

    Which of the following is NOT a risk factor for Torsades?

    <p>Hypertension</p> Signup and view all the answers

    What is the correct administration method for Magnesium Sulfate in adults?

    <p>Dilute 2g in 100mL of D5W and administer over 10 minutes</p> Signup and view all the answers

    What is the maximum dose of Magnesium Sulfate for pediatric patients?

    <p>2g</p> Signup and view all the answers

    In which condition is defibrillation delayed?

    <p>Defibrillation should never be delayed</p> Signup and view all the answers

    What should be avoided when managing a left ventricular assist device (LVAD) patient?

    <p>Using the LUCAS Compression Device</p> Signup and view all the answers

    What concentration of Magnesium Sulfate is typically used in adults?

    <p>500mg/mL</p> Signup and view all the answers

    What immediate action should be taken for unstable polymorphic V-Tach with hypotension?

    <p>Defibrillation at 200j</p> Signup and view all the answers

    What is a precaution when administering Magnesium Sulfate rapidly?

    <p>It may cause hypotension</p> Signup and view all the answers

    Which of the following statements regarding LVAD patients is correct?

    <p>The alarms and pump sounds should be assessed</p> Signup and view all the answers

    Which condition is a contraindication for administering Magnesium Sulfate?

    <p>2nd and 3rd Degree Heart Blocks</p> Signup and view all the answers

    What should you do if there is bleeding at the LVAD driveline site?

    <p>Apply direct pressure</p> Signup and view all the answers

    What is the appropriate formula to determine the initial defibrillation dose for a pediatric patient?

    <p>2j/kg, 4j/kg, 6j/kg, 8j/kg</p> Signup and view all the answers

    What is the recommended initial action for stable polymorphic V-Tach?

    <p>Obtain a 12-lead ECG and keep cables connected</p> Signup and view all the answers

    What is the initial dose of synchronized cardioversion for unstable wide complex tachycardia?

    <p>70j</p> Signup and view all the answers

    Which of the following is NOT a contraindication for administering Amiodarone?

    <p>Hyperkalemia</p> Signup and view all the answers

    What should be done if synchronized cardioversion fails during treatment of wide complex tachycardia?

    <p>Call for orders</p> Signup and view all the answers

    What is the maximum total dose of Versed that can be administered?

    <p>10 mg</p> Signup and view all the answers

    In the context of wide complex tachycardia, what does a QRS width greater than 0.12s indicate?

    <p>Presence of wide complex tachycardia</p> Signup and view all the answers

    What is the maximum single dose of Amiodarone for pediatric patients with stable wide complex tachycardia?

    <p>150 mg</p> Signup and view all the answers

    Which feature is a characteristic of wide complex tachycardia?

    <p>QRS width &gt; 0.12s</p> Signup and view all the answers

    What is the appropriate response for unstable wide complex tachycardia with contraindication to Amiodarone?

    <p>Initiate cardioversion immediately</p> Signup and view all the answers

    Which ECG feature favors a diagnosis of regular really wide complex tachycardia?

    <p>Rate usually &lt; 120 beats per minute</p> Signup and view all the answers

    When is the maximum dose of sodium bicarbonate for pediatric patients allowed, after initial administration?

    <p>5 minutes</p> Signup and view all the answers

    What is the initial dose of calcium chloride for adult patients with stable regular really wide complex tachycardia?

    <p>1g IV/IO</p> Signup and view all the answers

    What indicates the need for immediate 12-lead ECG after cardioversion?

    <p>If the patient receives two shocks from ICD</p> Signup and view all the answers

    What is required for the administration of intravenous calcium chloride?

    <p>Use a 10 gtt/set</p> Signup and view all the answers

    Study Notes

    Atrial Fibrillation/Flutter

    • Rapid atrial fibrillation and atrial flutter are defined as ventricular rates > 150 beats per minute.
    • Stable: Administer Cardizem 10 mg IV/IO over 2 minutes, diluted in 10 mL syringe. Repeat with 15 mg IV/IO if no response after 5 minutes.
    • Contraindications for Cardizem: Hypotension (BP less than 90), wide complex QRS, history of WPW or sick sinus syndrome, and heart blocks.
    • Unstable (Hypotension) < 90 mmHg systolic and/or AMS: Administer Normal Saline 1L IV/IO, titrate to desired effect. Monitor lung sounds and BP frequently.
    • If patient remains hypotensive after fluid administration, give Push-Dose Pressor Epinephrine (1:100,000): Discard 9 mL’s of Epi 1:10,000 (0.1mg/mL) and draw up 9 mL’s of NORMAL SALINE to create Push-Dose Pressor Epi 1:100,000. This will yield 10mcg/mL. Administer 1 mL/minute IV/IO, titrate to maintain age appropriate SBP.
    • If the patient loses consciousness or has a systolic BP below 90mmHg, cardiovert instead.

    Bradycardia

    • Bradycardia is defined as a heartrate < 50 beats per minute.
    • Stable: Obtain a 12-lead to rule out an MI and leave cables connected. Monitor and transport.
    • Unstable (Hypotension) < 90 mmHg systolic and/or AMS: Administer Atropine 1 mg IV/IO. Repeat up to 3mg every 3 minutes.
    • Contraindication for Atropine: Bradycardia in the presence of an MI, 2nd degree block Type II, and 3rd Degree block.
    • If the patient deteriorates or hypotension persists after 2 Atropine doses, apply transcutaneous pacing. Set initial rate to 60 beats per minute and increase milliamps until capture is achieved.
    • If hypotension remains after Atropine and transcutaneous pacing, use Push-Dose Pressor Epinephrine.

    Cardiogenic Shock

    • Cardiogenic shock can be characterized by the heart suddenly unable to pump enough blood to meet the body’s needs.
    • Left Ventricular Failure (Pulmonary Edema and Hypotension): Use Push-Dose Pressor Epinephrine (1:100,000), as described in Atrial Fibrillation/Flutter section.
    • Right Ventricular Failure (Positive V4R, Clear Lung Sounds With Hypotension): Administer Normal Saline 1L IV/IO, titrate to desired effect. Assess lung sounds and BP frequently. Repeat as needed.

    Chest Pain

    • Assume chest pain to be cardiac in nature until ruled out.
    • Stable: Obtain a 12-lead and leave cables connected. Avoid the right hand and right wrist for vascular access. Aspirin 162 mg - 324 mg PO.
    • Contraindications for Aspirin: < 16 years old, active GI bleeding.
    • Administer Fentanyl 100mcg IV/IO/IN/IM. Repeat up to 300 mcg every 5 minutes.
    • Contraindications for Fentanyl: Pregnancy near term (32 weeks or greater) or in active labor.
    • If pain persists after maximum Fentanyl or drug-seeking behavior is suspected, give Nitroglycerin 0.4mg SL. Can be repeated up to 1.2 mg every 5 minutes.

    STEMI Alert

    • STEMI Symptoms: Discomfort of the chest, arm, neck, back, shoulder or jaw, syncope or near syncope, general weakness, unexplained diaphoresis, SOB, nausea/vomiting.
    • STEMI Alert Criteria: ST-Segment Elevation in 2 or more contiguous leads:
    • Convex (frown face) or straight morphology (any of the following): 2mm or greater in V2 and V3, 1mm or greater in all other leads.
    • Concave (smiley face) morphology: 2 mm or greater in any lead.
    • STEMI Alert Disqualifiers:
    • Left Ventricular Hypertrophy (LVH), Pericarditis, Early repolarization, < 2mm of elevation with a concave (smiley face) morphology, Left Bundle Branch Block or Pacemaker (QRS complexes > 0.12).
    • Left Ventricular Hypertrophy Formula (LVH): Count the small boxes of VI and V2 (“S” wave), the largest negative deflection from the isoelectric line (whichever is larger). Count the small boxes of V5 or V6 (“R” wave), the largest positive deflection from the isoelectric line (whichever is larger). Add the 2 numbers, if the result is > 35, suspect LVH.

    CHF (Pulmonary Edema)

    • Signs and Symptoms: Hypertension, Tachycardia, Orthopnea (SOB while lying flat), Rales, Pedal Edema.
    • Stable: Obtain a 12-lead and leave cables connected. Administer Nitroglycerin 0.8mg SL (2 tablets) if BP > 90 mmHg.
    • Contraindications for Nitroglycerin: SBP < 90 mmHg, Heart Rate < 50 beats per minute, EDD (Viagra and Levitra within 24 hours and Cialis within 48 hours), Right Ventricular Infarction (positive V4R)

    Supraventricular Tachycardia

    • Distinction between Sinus Tachycardia (ST) and Supraventricular Tachycardia (SVT): SVT will generally have no discernible P-waves or there may be P-waves just after the QRS complex. History that favors Sinus Tachycardia (e.g., dehydration, fever, pain, anxiety, physical activity, exertional heat stroke, etc.). Vagal maneuvers may gently slow down Sinus Tachycardia but will either not affect SVT OR abruptly break the SVT.
    • Adult Stable (AAOX4 With/Without Hypotension): Obtain a 12-lead and leave cables connected. Perform vagal maneuvers. Administer Adenosine 12mg rapid IV/IO with simultaneous 10mL NORMAL SALINE flush.
    • Contraindications for Adenosine: Heart Transplant, patients taking Tegretol (Carbamazepine), patients with a history of second or third degree AV block (except in patients with a functioning artificial pacemaker), Sick Sinus Syndrome without cardiac pacemaker in place, Active bronchospasm.
    • Unstable (Hypotensive) < 90 mmHg systolic and/or AMS: Do not delay cardioversion to establish IV access. Consider Versed for sedation. Use synchronized cardioversion: 70j, 120j, 150j, 200j.

    Wide Complex Tachycardia

    • ECG Features that Favor a Diagnosis of Wide Complex Tachycardia (WCT): No discernible P waves, precordial concordance, negative Lead V6, backward frontal plane axis, presence of capture beats or fusion beats, rate usually > 120 beats per minute, QRS width > 0.12s or 120ms.
    • Stable WCT: Obtain a 12-lead and leave cables connected. Administer Amiodarone IV/IO: Dilute 150mg of AMIODARONE in a 100mL bag of D5W. Administer over 10 minutes using a 10 gtt/set.
    • Unstable WCT or Contraindication to Amiodarone (ie. QTc > Than 460ms): DO NOT delay cardioversion to establish IV access. Consider Versed for sedation.

    Wide Complex Tachycardia

    • Max total dose of Versed is 10mg.
    • Cardioversion energy starts at 0.5j/kg and increases to 1j/kg and then 2j/kg if needed.
    • Irregularly-irregular WCTs are a contraindication for cardioversion.
    • Amiodarone infusion is indicated for patients who convert after 2 cardioversions by Fire Rescue or 2 or more shocks by their implantable cardioverter defibrillator (ICD).
    • Amiodarone should not be administered if the patient has already received it.

    Regular Really Wide Complex Tachycardia

    • RRWCT has a QRS width of ≥ 0.20s or 200ms.
    • Stable RRWCT is treated with Calcium Chloride and Sodium Bicarbonate.
    • Calcium Chloride is given at a dose of 1g IV/IO in adults and 20mg/kg IV/IO in pediatrics.
    • Sodium Bicarbonate is given at a dose of 100 mEq IV/IO in adults and 1 mEq/kg IV/IO in pediatrics, with a max single dose of 50 mEq and a max total dose of 100 mEq.
    • Unstable RRWCT is treated with Versed and cardioversion.
    • Cardioversion energy starts at 70j in adults and 0.5j/kg in pediatrics, increasing to 120j, 150j, and 200j or 1j/kg and 2j/kg respectively.

    Polymorphic V-Tach/Torsades

    • Torsades de Pointes is a form of ventricular tachycardia characterized by twisting of the QRS complexes.
    • Risk factors include congenital long QT syndrome, female gender, renal/liver failure, and medications that prolong the QT interval.
    • Stable polymorphic V-tach is treated with Magnesium Sulfate.
    • Unstable polymorphic V-tach is treated with defibrillation.
    • Defibrillation energy starts at 200j in adults and 2j/kg in pediatrics, increasing to 4j/kg, 6j/kg, and 8j/kg respectively.

    Left Ventricular Assist Device

    • LVADs are surgically implanted devices that assist the pumping action of the heart.
    • Patients with a properly functioning LVAD may not have a detectable pulse, measurable blood pressure, or accurate oxygen saturation.
    • Hypoperfusion is treated with Normal Saline.
    • Chest compressions are contraindicated if the LVAD is not working and no other options exist to restart it.
    • Transport to the closest appropriate LVAD facility.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Description

    This quiz covers the management protocols for rapid atrial fibrillation and flutter, focusing on stable and unstable conditions. Explore the administration of Cardizem and normal saline, along with contraindications and emergency measures. Test your knowledge on the appropriate interventions to stabilize patients.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser