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* afib
 #138614  
  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
#558970
  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
#559321
  ben - 11/15/06 10:18
 
  ???  
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* Re:afib
#559330
  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
#559333
  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
#559436
  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
#559671
  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
#559787
  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
#559789
  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
#559852
  ben - 11/15/06 15:59
 
  thx % thx again for clearing/confirming this !!  
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* Re:afib
#560517
  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)
Digoxin
B-blocker
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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