Brand New AFib Question

  1. 0
    Monday I found my patient (Ive had her a month now for foot wound vc, no cardiac history) in new afib HR 100, asymptomatic, I found it on vitals assessment. Because she was asymptomatic I didn't send her straight to the ER, I called the PCP. Yesterday they called to let me know they admitted her to the hospital as when they finally saw her (they scheduled a Monday afternoon appt, she cancelled, they rescheduled Tues, she tried to cancel but they refused and insisted she come in) she was fibbing in the 160s, still asymptomatic.

    My question being, what would you have done? Clearly if she was SOB, palpitations, etc I would have called EMS and MD office never appeared upset with my calling then but with new afib is it best to go straight to ER or okay to refer patient to PCP?
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  3. 7 Comments so far...

  4. 0
    I'd think it would depend on home meds. If she wasn't on coumadin or something similar than she needed to see the doc soon - probably the same day. New onset afib needs to be treated to prevent the symptoms. Just my opinion.
  5. 0
    Did you make the call to the PCP yourself? You would have explained your findings as rationale for the appointment and if they wanted her to go to the ED then they should have provided that direction. You also cannot be responsible for the patient canceling appointments.
  6. 0
    Quote from SaoirseRN
    Did you make the call to the PCP yourself? You would have explained your findings as rationale for the appointment and if they wanted her to go to the ED then they should have provided that direction. You also cannot be responsible for the patient canceling appointments.
    Yes I did report to them myself, you made a good point...if they felt it necessary they would have told her to go to the ER.

    She was not on any blood thinners which heightened my reporting to MD office.

    Thanks!
  7. 0
    i agree, she cancelled her own appointment, you did all you could do.
  8. 0
    Holy moly!!! Just talked to my supervisor, turns out this patient went into VFib in hospital, was shocked out of it, and went for heart surgery yesterday.

    She's doing well though, enough so that she keeps calling the agency to coordinate her discharge and driving my supervisor crazy haha

    I'm quite beside myself with what she turned out having to go through.
  9. 0
    Good call, i thought A-fib at 100 beats could only be picked up on EKG, but glad u did what u did.
  10. 0
    this is my hardest part of home care... recently i was told i had a pt s/p cabg unable to stablaize on coumadin unable to stablizie INR (freuqnetly well above 3 and for a week under 2.0 pcp aware) go to the ER and found 2 dvt's. i saw the pt that day or the day before and had no s/s whatsoever was actually my healthiest pt (considering he was post-op and ambulatory w/ no complaints) my supervisor was upset thinking why hadnt i noticed this? but bottom line is things happen after we leave and sometimes very quickly, and pts dont always tell us everything. I would have probably done the same, as I am frequently reminded that sympotomatic presentations are not usually considered appropriate for ER but require immediate attention. If you have documented the PCP request, and her canceled visit, then that is really the best you can do. However if you are like me I often find it frustrating that I cannot know more about a pts condition (ex. cant quite get an EKG or echo done in home for answers in 24hr)


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