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a 72 y/o caucasian male comes to the office because of palpitations. He has has these symptoms for the past few hours. He complains of dyspnea on exertion and malaise for past few months. His other problems are HTN and degenerative joint disease. He has smoked one pack of cigarettes daily for 55 yrs. His medication include hydrochlorothiazide and fosinopril. heis BP is 140/90, pulse 148/min and resp 20/min. PE reveals scattered ronchi and wheezes in both lungs. Heart sounds and rest of exam are normal. EKG demonstrates tachycardia with narrow QRS comples, different P wave morphologies and variable PR segments and R-R interval. A diagnosis of MAT is made.
Which of the following is most appropriate next step in management ?
a. Give IV bolus fo digoxin
b. Obtain CXR immediately
c. Give IV amiodarone
d. Check ABG
e. Give IV dose of atenolol
f. Reassure and observe
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maybe d.
bc mat common in copd
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d.
Oxygen
Prehospital Care
* Assess for pulmonary causes that may be causing the arrhythmia.
* Stabilize the acute situation as necessary.
* Provide oxygen, cardiac monitoring, and pulse oximetry.
* Establish IV access without delaying transport.
* Collect medications that the patient may be taking or may have access to.
Emergency Department Care
* Rapidly assess and stabilize the ABCs while providing simultaneous treatment. An upright sitting position usually is most appropriate.
* Obtain IV access with a large-bore catheter with isotonic sodium chloride solution at a to keep open (TKO) rate.
* Administer oxygen to maintain the saturation greater than 90%, but avoid excessive oxygen in patients with known significant COPD. This will avoid the theoretical problem of removing the hypoxic drive for ventilation, which can result in increased carbon dioxide retention.
* The need for tracheal intubation is dictated by the standard clinical indications.
* Establish cardiac monitor, blood pressure monitor, and pulse oximetry.
* Assess for and treat the underlying cardiopulmonary process, theophylline toxicity, or metabolic abnormality. Bronchodilators and oxygen should be administered for treatment of decompensated chronic obstructive pulmonary disease (COPD); activated charcoal and/or charcoal hemoperfusion is the therapy for theophylline toxicity.
* When magnesium sulfate is administered to correct hypokalemia, most patients convert to normal sinus rhythm (NSR).
* Specific antiarrhythmic therapy is not commonly indicated and the value of such therapy is not proven. Metoprolol has been shown to be somewhat effective in converting MAT to NSR, and verapamil effectively slows the ventricular rate, but it is less effective in conversion to NSR.
* Due to the multiple atrial foci, cardioversion rarely is successful.
* Avoid sedatives.
source webmd
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Agree with yettobe don't forget ABCs and to do that you need ABGs
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Hypoxia is a common cause of MAT
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D..... check ABG
mc cause of MAT is hypoxia....yes! agree.......
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The correct answer is D.
MAT is usually secondary to:
Hypoxia
COPD
Hypokalemia
Hypomagnesemia
HTN
Medications
among them hypoxia is most common cause in elderly pt and correction of that will eliminate the rhythm problem.
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this person is symptomatic so we will use oxygen first
since hypoxia is one of the commonest reason for MAT
and then will proceed to give atenolol
