10-02-2006, 05:34 AM
UW ARRYTHMIAS APPROACH
Anytime if the patient is hemodynamically unstable [ means BP is low or patient not responding to the verbal commands treatment of choice is electrical cardioversion.
2. If the patient is hemodynamically stable, then you have to think whether it is an acute process? or a chronic process?.
a. If it is an acute [ < 48 hrs] process
i. initial approach is usually rate control.
ii. Electrical or pharmacologic cardioversion may be necessary
1. if rate control cannot be achieved and
2. the patient is experiencing ongoing ischemia or
3. hemodynamic instability.
iii. 4-6 wks warfarin anticoagulation
b. If it is a chronic [ > 48 hrs] process
i. initial approach is usually rate control
ii. 4-6 wks warfarin anticoagulation
iii. Electrical or pharmacologic cardioversion
TREATMENT
Rate control by
1. I.V beta blockers like I.V metoprolol & I.V esmolol
2. I.V calcium channel blockers like I.V verapamil or I.V diltiazem
3. I.V digoxin
4. Quinidine---for SVT ( supraventricular tachycardias )
Cardioversion
1. electrical
2. chemical like I.V ibutilide
Anytime if the patient is hemodynamically unstable [ means BP is low or patient not responding to the verbal commands treatment of choice is electrical cardioversion.
2. If the patient is hemodynamically stable, then you have to think whether it is an acute process? or a chronic process?.
a. If it is an acute [ < 48 hrs] process
i. initial approach is usually rate control.
ii. Electrical or pharmacologic cardioversion may be necessary
1. if rate control cannot be achieved and
2. the patient is experiencing ongoing ischemia or
3. hemodynamic instability.
iii. 4-6 wks warfarin anticoagulation
b. If it is a chronic [ > 48 hrs] process
i. initial approach is usually rate control
ii. 4-6 wks warfarin anticoagulation
iii. Electrical or pharmacologic cardioversion
TREATMENT
Rate control by
1. I.V beta blockers like I.V metoprolol & I.V esmolol
2. I.V calcium channel blockers like I.V verapamil or I.V diltiazem
3. I.V digoxin
4. Quinidine---for SVT ( supraventricular tachycardias )
Cardioversion
1. electrical
2. chemical like I.V ibutilide