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* afib
  ben - 11/14/06 20:38
  1.Are CBB, BB and Digoxin (Dig inly in Pt with hypotension??)
-->used are Short Term Rate Control of AFIB ??

2.Are Amiodarone, Illbutilide..
--> used as after the Rate control for Long Term Manage??

3.When do you give Coumadin (aka Warfarin)??
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* Re:afib
  ben - 11/14/06 21:42
  Can Someone pls outline the Mx of AFlutter & AFib depeding on chronic vs acute process??  
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* Re:afib
  ben - 11/15/06 10:18
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* Re:afib
  masterdoc - 11/15/06 10:35
  acute ...vagal manuevers then adenosine iv bolus then cca,digoxin,bblock, then procainamide , amiodarone

chronic procainamide ,ibutilide sotalol etc
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* Re:afib
  afem - 11/15/06 10:37
  atrial fib.

If hemodynamically unstable : Cardioversion

Hemodynamically stable and acute (<48 hrs): Control rate with B blocker, or Ca ch blocker or Digitalis

Hemo. stable and chronic (>48hrs) : Control rate (as above) + Anticoagulate with warfarin, maintaining INR at 2 -3 for 3to 4 weeks , then only cardioversion.

A. Flutter:
Hemody. unstable : cardioversion
Hemody. stable, acute : Control rate (as above)
Hemody. stable, chronic: Control rate + anticoagulate

Let me know if there's anything more.
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* Re:afib
  farha - 11/15/06 11:59
  so essentially theres no difference in the mangementof afib and aflutter ?

i agree with the outline by afem as i have the same thing in my notes from uw...and have always wondered about htis point

also ibutilide is used for chemical cardioversion
amiodarone is longterm magt of VT (also SVT?)
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* Re:afib
  ben - 11/15/06 14:08
  Thx guys could you pls loo over these steps and give me some input if wrong or right. This is from UW

Unstable = Sinus Rhtym Control via
--> Electrical Cardiversion (preferable Pt should be anticoagulated w/ electrical C.)
then later to mainatin sinus rhtym can give Class III Antiarrh Drugs

Stable Acute = Sinus Rhtym via
a. Cardioversion (Electrical or Chemical --Chemical via Class III Antiarrhtmic drugs)
b. Rate Control via CCB, BB, Dig

Stable Chronic = Sinus Rhtym via
--> Rate Control (same drugs) + Anticoagulation

Not sure which antiarrthmic for which siutaion though"ie long term maintenaince" . Pls help out.

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* Re:afib
  dolly123 - 11/15/06 15:25

Tt :
• Hemodynamially unstable = cardioversion at 50-100 joules
• Hemo stable = cardioversion or rate control

Hemo stable can be acute or chronic
Acute (<48 HRS) = cardio version or rate control
Cardio version for the acute stable can be
• electrical as above
• Chemical using ibutilide
Chronic (>48HRS) = rate control using verapamil or diltiazem ie calcium channel blockers;
Beta blockers can also be given

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* Re:afib
  dolly123 - 11/15/06 15:26
  Do not use carotid massage now bec of risk of throwing off carotid emboli  
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* Re:afib
  ben - 11/15/06 15:59
  thx % thx again for clearing/confirming this !!  
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* Re:afib
  mah - 11/16/06 08:26
  This is wht i got frm kaplan lectures...

SVT/atrial flutter/atrial fib..

first find out stable or unstable....

unstable --------> shock

stable--------->Vagal manoveur
Adenosine (SVT only)
Ca channel blocker
(if all of the above drugs are given then thr must be the conditions in which other drugs are CI)

Fer chronic..............more than 2 days.....add Warfarin...

plzz anyone let me kno if i got the rite concept??
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