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??
Dec 8, '07
AV nodal blocking agents are contraindicated in patients with heart failure, no?
Cardioversion can damage myocardial tissue, not so good for someone with CHF, and it can also knock loose any blood clots he might have floating around in his atria.
Why the doc would let him go on for a week this way is beyond me, though. I'd be scouring those progress notes for some clues. Maybe he's waiting for the patient to "declare himself", so to speak?
Last edit by Virgo_RN on Dec 8, '07