[st4304]

We don't atrial pace with they go into afib, they are being atrial paced when they come out of surgery for the first 72 hours. As soon as they are extubated and can take po, they are given the lopressor. This actually works for us because our instances of post cabg afib have definitely decreased. In fact, it's very rare.


Thanks!

Sherri

[zambezi]

I work in CCU....OUr standing orders state that we can give four doses digoxin (if pt not on pre-op/currently) and they are in afib or having frequent pacs rate 90-140, if on dig already straight to cardizem...if rate is >140, we go straight for the cardizem (and i think that dig too but can't remember offhand....) we also use amiodarone occassionally...

[Pete495]

Sherri,

Do you guys atrial pace only if the patient is in AFIB in the OR or has a history of AFIB, or does everyone get paced for the first 72 hours? Just curious. It does
sound like a good way to prevent post operative atrial fib.

It's interesting to find out what other heart units are doing to prevent post op complications, cuz we know there are many. The surgeons here don't like digoxin, I think mostly because of the potassium effect. Plus you have to do dig. levels and all that. So they just use the amiodarone. They used to use cardizem, but when they came out with amiodarone, they always use that now. Many times a patient will be on cardizem for days until they finally hit sinus rhythm. we've had better effect with amiodarone I believe.
They don't like lopressor either, mostly because of the bradycardia I think.

Thanks for your info.

Pete495

[st4304]

Dear Pete495:

Everyone gets paced the first 72 hours.

S.

[Ellen]

When I worked on a post bypass step down unit years ago (1996-97) we had 7-8 patients with NO CNAs!! We were doing primary care nursing....I left - too dangerous - and went to Home Health. Now I just went back to the hospital but a smaller one, telemetry floor, we only do heart caths - no open heart. I still have 8 pts. at times but we at least we have CNAs.
We're working here in Florida to pass Safe Staffing laws like they did in California. Their telemetry patient to nurse ratios will be mandated at 5:1 effective July 1st.

[Surgical Hrt RN]

I work in an openheart ICU AFIB = Amiodarone bolus and gtt everytime! Works really good . I would say abotu 95 % of post op CABG pts go in to afib around the 3rd day post op.

[louloubell1]

I work CTS ICU too, and a fib usually buys you a amio bolus of 150 mg followed by a gram over 24 hours. If it is a rapid Afib which is making the patient hemodynamically unstable we may cardiovert or try to pace them out of it as well.