ACLS rapid atrial fibrillation guideline
State of Wisconsin
Emergency Medical Services
Sample Medical Guidelines
|ACLS-Rapid Atrial Fibrillation |
|Priorities |Assessment Findings |
|Chief Complaint |Palpitations, fast heart rate, shortness of breath, chest pain, weakness |
|OPQRST |Onset and duration, precipitating factors and circumstances, associated symptoms, stroke |
| |symptoms, nausea, vomiting |
|Associated Symptoms/ Pertinent |Chest pain, shortness of breath, weakness, anxiety, leg swelling |
|Negative | |
|SAMPLE |Previous history, history of thyroid disease, CAD, cardiac medications |
|Initial Exam |Check ABCs and correct any immediate life threatening problems. |
|Detailed Focused Exam |Skin: Cool, pale diaphoretic |
| |Neck: JVD? |
| |Chest: Labored breathing |
| |Lungs: Wheezes, rales, rhonchi? Decreased breath sounds? |
| |Heart: Irregular, fast, murmur |
| |Legs: Edema? Signs of an acute arterial occlusion (embolism)? |
| |Neuro: ALOC? Signs of stroke? |
|Goals of Therapy |Decrease Rate, treat chest pain, treat CHF |
|Monitoring |BP, HR, RR, EKG, SpO2. |
|EMERGENCY MEDICAL RESPONDER (EMR) |
• Routine Medical Care
• Titrate oxygen therapy to the lowest level required to maintain an oxygen saturation greater than 93%
• If the patient is having difficulty breathing allow them to sit in position of comfort
|EMERGENCY MEDICAL TECHNICIAN (EMT) |
• If the patient experiences shortness of breath, follow the Congestive Heart Failure Guidelines
• If the patient has suffered a stroke, follow the Stroke Guidelines.
• ECG monitor or 12 lead acquisition, if approved.
|ADVANCED EMT (AEMT) |
• IV/IO NS @ TKO, if approved.
• If SPB < 100 mmHg give 500cc fluid bolus, and then reassess
o Consider Trendelenberg position, if there is no dyspnea
|Contact Medical Control for the following: |
|Additional fluid orders |
|INTERMEDIATE |
• Obtain a 12-Lead EKG if not already performed
• If the patient does not have a history of atrial fibrillation, consider the potential causes that may have a bearing on prehospital care, including:
o Acute coronary syndromes (e.g. AMI)
o Pulmonary embolism
o Alcohol use
o Stimulant drug abuse (e.g. cocaine and amphetamines)
• If the patient has a history of atrial fibrillation, consider possible causes of tachycardia, including pain, dehydration, hypotension, shock, hypoglycemia, hypoxemia, anxiety, fever, sepsis, drug induced, recent heavy exertion, hyperthyroidism and anemia.
• If the patient is hemodynamically and clinically stable, observe and monitor.
|Contact Medical Control for the following: |
|If the patient is unstable, consider cardioversion under direction of Medical Control. |
|PARAMEDIC |
• If the patient is hemodynamically and clinically stable, transport, observe and monitor. Efforts to reduce the heart rate will add little benefit in the absence of adverse effects from RAF.
• If the patient is hemodynamically or clinically unstable
o Prepare to perform synchronized cardioversion, consider pain management or sedation
o Perform first synchronized cardioversion @ 120-200 J biphasic (200 J monophasic)
o If synchronization is unsuccessful, turn sync off and attempt cardioversion
|Contact Medical Control for the following: |
|Additional orders to potentially include Cardizem. |
FOOTNOTES:
Criteria for characterizing a patient as “unstable”
• Hemodynamic Criteria
o SBP < 80 mmHg AND Heart Rate > 150 beats/min
• Clinical Criteria
o Signs of shock (poor perfusion) are present, including
▪ ALOC
▪ Absent radial pulses
▪ Pallor and diaphoresis
o Signs of pulmonary edema are present, including
▪ Labored breathing
▪ Rales (wet lungs)
▪ Hypoxia (SpO2 ................
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