Uncontrolled Afib

[Tele_Nurse4u]

Hey everyone...quick question...

I had a 52 y/o male patient today who was found unconscious in his apartment. Has been hospitalized x1 week. It was found he had a large CVA, uncontrolled Afib (up to 160's) and CHF. He was started on a Cardizem drip the night he came in. Now, a week later (and still on the drip) he is still uncontrolled afib in the 140's. The man has no family to speak of. The stroke has left him aphasic, complete right side paralysis.

Anywho....tonight was my first night having him. I noticied he was only on 81mg ASA RECT and nothing else for anticoag. I called doc and he gave me a really hard time and kinda made me feel dumb for asking. I just thought he already had a CVA, Im sure the Afib wasnt much help. Not to mention...his risk factor for another CVA was high. I got a Lovenox order and an order to call consultation for ablation.

so..with uncontrolled afib do they normally jump right to ablation??? I thought they would try cardioversion first?

What am i missing??

:) thanks everyone!!

steph:idea:

[Zookeeper3]

Either way a TEE is required prior to cardioversion or an Ablation. If they were going to Ablate, the INR has to be normal. The ablation wire is advanced to the LEFT atrium after a septal stick.

Large teaching centers are doing trials with a septal stick with INR's around 2.5. If you miss (with a beating heart and a breathing patient), then the aorta can be punctured or worse, large veins. The muscular atrial layers may close a puncture, but try to fix a bleeding large vein with an INR of 3... its a vascular surgeons worst nightmare.

I would read the notes from the EP doc to determine why there was a delay. It is very normal to send a-fib patients home and cancel a proceedure because the INR is >2.