Crossword Puzzles:
Antidotes Used In Toxicology

Orthopedics

A 61 year old male presents with palpitations that he has been experiencing for one day. He denies any shortness of breath, diaphoresis, nausea or vomiting.

What does the EKG show?

Rate: variable 75-150

Rhythm: Irregularly irregular

Axis: normal axis

QRS: .08 normal

PR: no distinct PR interval

ST: no elevations or depressions

EKG diagnosis: Atrial Fibrillation

Describe treatment in stable vs. unstable patient and management of rate and rhythm:

1) Hemodynamically unstable à sedate à synchronized cardioversion(100 Joules) à if > 48 hours, anticoagulate

2) Hemodynamically stable:

• · A) Rate control: Drug of choice is Diltiazem (0.25 mg/kg first dose followed by 0.35 mg/kg second dose in 15 minutes if needed). Alternatives may be calcium channel blockers, beta blockers, or digoxin (delayed onset)
• · B) Rhythm control:
• · a) If < 48 hours, may convert chemically with procainamide, ibutilide, or amiodarone or electrical cardioversion
• · b) If > 48 hours, must anticoagulate prior to chemical or electrical cardioversion

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