Adult A-fib/flutter

Question 1

Adult A-fib/flutter - Heart rate needed to consider treatment

Answer 1

> 140 bpm

Question 2

Adult A-fib/flutter - Unstable criteria

Answer 2

BP < 80 mmHg or less and at least 1 symptomatic criteria

Question 3

Adult A-fib/flutter - Symptomatic criteria

Answer 3

Altered LOC
Ischemic chest pain
Significant SOB and/or evidence of CHF

Question 4

Adult A-fib/flutter - Unstable criteria met

Answer 4

Consider sedation then cardioversion

Cardioversion

Question 5

Adult A-fib/flutter - Cardioversion voltage selection

Answer 5

Synchronized - 200J then 300J then 360J

Question 6

Adult A-fib/flutter - Cardioversion contraindicated if?

Answer 6

Onset >48 hours

Question 7

Adult A-fib/flutter - Do not treat RVR if?

Answer 7

Caused due to hypoxia or fever

Question 8

Adult A-fib/flutter - Stable but symptomatic Tx?

Answer 8

Metoprolol with OLMC

Question 9

Adult A-fib/flutter - Metoprolol indications

Answer 9

Symptomatic a-fib/flutter without hypotension

Question 10

Adult A-fib/flutter - Metoprolol dose

Answer 10

Mandatory OLMC - 5 mg SIVP q 5 min to a total max of 15 mg or HR < 110 bpm or BP <100

Question 11

Adult A-fib/flutter - Metoprolol EMS contraindications

Answer 11

Hypersensitivity
Second and third degree AV blocks
Bradycardia less than 50 bpm
Systolic BP less than 100 mmHg
Severe acute heart failure
Bronchospastic COPD, reactive airway disease
Recent (less than 24 hrs) cocaine use

Question 12

Adult A-fib/flutter - Metoprolol precautions

Answer 12

Ensure OLMC is aware if patient taking CCB or digoxin

Do no administer in setting of sympathomimetic OD