Atrial flutter/fibrillation treatment help!

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Ok I am getting confused. My teacher explained to us how to treat Aflutter/Afib. but she juggled "stable" and "unstable" with "contolled" and "uncontrolled" so now I do not know what is what. Here is what I got out of it, please let me know if it is right:

-If a patient has a controlled rate

-If a patient has an uncontrollable rate >100pbm and is stable, then you control the rate (cardizem...), if they have been in the rhythm 48 hours, you send them home on anticoagulants for at least 3 weeks and they will come back for an outpatient cardioversion (?)

Ok here is where I am not sure what to do?

-When a patient is unstable (hemodynamically compromised) you immediately cardiovert (?) regardless of how long they have been in the rhythm? and whether or not their rate is controlled?

OR

-When a patient is unstable + uncontrolled rate + >48 hours ????

-When a patient is unstable + uncontrolled rate + immediate cardioversion????

-When a patient is unstable with a controlled rate (is that even possible)?

.....I am lost on those ones! Please help...thank you!

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Specializes in med/surg, telemetry, IV therapy, mgmt.

I would contact your instructor to clarify the information, especially if it might show up on a test--you want her version of the treatment.

According to the information on eMedicine http://www.emedicine.com/med/topic184.htm:

"Consider immediate cardioversion for patients with AF of less than 48 hours' duration because the risk of embolic stroke is small. If the exact time cannot be determined accurately or is longer than 48 hours in duration, patients should receive either a TEE [transesophageal echocardiograph] to assess for atrial thrombus prior to cardioversion or anticoagulation therapy for 4 weeks with an INR goal of 2-3 prior to elective cardioversion. If AF duration is questionable or is longer than 48 hours and the TEE shows no evidence of atrial thrombus, anticoagulation is still indicated postprocedure, and the initiation of intravenous heparin is warranted while warfarin therapy is initiated and while the INR rises to therapeutic levels. Low-molecular-weight heparin (1 mg/kg bid) may be used in outpatient settings in conjunction with warfarin therapy."

It seems that they doctors are saying that the defining criteria is the risk for having a stroke due to the presence of blood clots. We are nurses. Not doctors. This is why I suggest you get in touch with your instructor on this to get your notes correct to what your instructor said.

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Specializes in Telemetry.
ok i am getting confused. my teacher explained to us how to treat aflutter/afib. but she juggled "stable" and "unstable" with "contolled" and "uncontrolled" so now i do not know what is what. here is what i got out of it, please let me know if it is right:

-if a patient has a controlled rate

-if a patient has an uncontrollable rate >100pbm and is stable, then you control the rate (cardizem...), if they have been in the rhythm 48 hours, you send them home on anticoagulants for at least 3 weeks and they will come back for an outpatient cardioversion (?)

ok here is where i am not sure what to do?

-when a patient is unstable (hemodynamically compromised) you immediately cardiovert (?) regardless of how long they have been in the rhythm? and whether or not their rate is controlled?

this is correct. if the rate is controlled, they do not need cardioverted.

or

-when a patient is unstable + uncontrolled rate + >48 hours ????

-when a patient is unstable + uncontrolled rate + immediate cardioversion????

-when a patient is unstable with a controlled rate (is that even possible)?

when a patient is unstable or even symptomatic, you want to get them out of that rhythm fast = cardioversion. at this point, saving their life takes precedence over the possibility of a stroke.

the acls (advanced cardiac life support) algorhythms for uncontrolled rates/rhythms are helpful in sorting this all out.

a patient can be unstable with a controlled rate but their instability is caused by something else i.e. complete heart block, resp arrest, low bp, etc etc etc and therefore requires other treatments. again, do a search for acls guidelines. these outline treatments for unstable and/or code blue patients in various rhythms.

.....i am lost on those ones! please help...thank you!

hope this helps.

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Specializes in Telemetry.
i would contact your instructor to clarify the information, especially if it might show up on a test--you want her version of the treatment.

according to the information on emedicine http://www.emedicine.com/med/topic184.htm:

"consider immediate cardioversion for patients with af of less than 48 hours' duration because the risk of embolic stroke is small. if the exact time cannot be determined accurately or is longer than 48 hours in duration, patients should receive either a tee [transesophageal echocardiograph] to assess for atrial thrombus prior to cardioversion or anticoagulation therapy for 4 weeks with an inr goal of 2-3 prior to elective cardioversion. if af duration is questionable or is longer than 48 hours and the tee shows no evidence of atrial thrombus, anticoagulation is still indicated postprocedure, and the initiation of intravenous heparin is warranted while warfarin therapy is initiated and while the inr rises to therapeutic levels. low-molecular-weight heparin (1 mg/kg bid) may be used in outpatient settings in conjunction with warfarin therapy."

it seems that they doctors are saying that the defining criteria is the risk for having a stroke due to the presence of blood clots. we are nurses. not doctors. this is why i suggest you get in touch with your instructor on this to get your notes correct to what your instructor said.

excuse me?

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