ATRIAL FIBRILLATION with RVR / ATRIAL FLUTTER
ALL LEVELS
DESIGNATION OF CONDITION
Patient presentation with heart rate over 150 with supraventricular focus. Patients with narrow complex tachycardia, are often familiar with their problem and symptoms. Those who do not show evidence of hemodynamic instability require no pre-hospital medications. Patients presenting with hemodynamic instability, evidence of poor perfusion, chest pain, altered level of consciousness, shortness of breath, cyanosis or evidence of CHF are considered unstable and invasive intervention should be implemented per this protocol.
EMPHASIS ON PATIENT CARE
Maintain adequate perfusion, adequate oxygenation, and ALS intervention
1. Primary Management - Assess ABC’s and manage as indicated.
a. Titrate oxygen to maintain SpO2 >92%
2. Initiate transport to appropriate medical facility. Consider ALS intercept.
3. Secondary Management - History, physical exam, vital signs
a. If suspected AMI, administer ASPIRIN [325 mg PO]. Chewed then swallowed
AEMT
1. En-route, initiate IV/IO access; if necessary, titrate isotonic solution to end organ perfusion.
PARAMEDIC
1. If UNSTABLE (symptomatic) A-Fib/A-Flutter:
a. Patients with significant decompensation (shock, mental decompensation, severe ongoing chest pain) may require immediate Synchronized Cardioversion. If the patient is conscious, consider sedation using MIDAZOLAM [2-4 mg] IV/IO/IN/IM, prior to cardioversion, if appropriate to patient condition.
• Cardiovert at 200 J (maximum for machine).
b. Continuously monitor patients BP
2. If patient’s cardiac rhythm changes during procedure, treat per applicable guidelines.
3. Use of Nitroglycerin or Narcotic Pain Relievers for patients with this rhythm may precipitate decompensation or cardiac arrest.
ALL LEVELS
DESIGNATION OF CONDITION
Patient presentation with heart rate over 150 with supraventricular focus. Patients with narrow complex tachycardia, are often familiar with their problem and symptoms. Those who do not show evidence of hemodynamic instability require no pre-hospital medications. Patients presenting with hemodynamic instability, evidence of poor perfusion, chest pain, altered level of consciousness, shortness of breath, cyanosis or evidence of CHF are considered unstable and invasive intervention should be implemented per this protocol.
EMPHASIS ON PATIENT CARE
Maintain adequate perfusion, adequate oxygenation, and ALS intervention
1. Primary Management - Assess ABC’s and manage as indicated.
a. Titrate oxygen to maintain SpO2 >92%
2. Initiate transport to appropriate medical facility. Consider ALS intercept.
3. Secondary Management - History, physical exam, vital signs
a. If suspected AMI, administer ASPIRIN [325 mg PO]. Chewed then swallowed
AEMT
1. En-route, initiate IV/IO access; if necessary, titrate isotonic solution to end organ perfusion.
PARAMEDIC
1. If UNSTABLE (symptomatic) A-Fib/A-Flutter:
a. Patients with significant decompensation (shock, mental decompensation, severe ongoing chest pain) may require immediate Synchronized Cardioversion. If the patient is conscious, consider sedation using MIDAZOLAM [2-4 mg] IV/IO/IN/IM, prior to cardioversion, if appropriate to patient condition.
• Cardiovert at 200 J (maximum for machine).
b. Continuously monitor patients BP
2. If patient’s cardiac rhythm changes during procedure, treat per applicable guidelines.
3. Use of Nitroglycerin or Narcotic Pain Relievers for patients with this rhythm may precipitate decompensation or cardiac arrest.