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Atrial Fibrillation, Emergency Medicine

Edward Ullman and Terrance T. Lee Reviewed 06/2017
 


Basics

Description

  • Dysrhythmia characterized by seemingly disorganized atrial depolarizations without effective atrial contraction

  • Caused by multiple re-entrant waveforms within the atria

  • Atrial rate ran...

Diagnosis

Signs and Symptoms

  • Palpitations

  • Decreased cardiac output:

    • Weakness

    • Light headedness

    • Syncope

    • Hypotension

    • Angina

    • Pulmonary edema

    • Altered mental status

    • Lower extremity edema

    • Hepatojugular reflex

  • Embolus fo...

Treatment

Pre-Hospital

  • IV access

  • Monitor

  • Oxygen

  • Cardioversion:

    • In settings where patient is unstable

Initial Stabilization/Therapy

  • IV

  • Oxygen

  • Monitor

  • Immediate synchronized electrical cardioversion starting at 2...

Follow-Up

Disposition

Admission Criteria

  • Unstable AF:

    • Inability to control rate

  • High risk for stroke:

    • Prior cardiovascular accident

    • CHF

  • Associated medical problems contributing to the AF that require inpatie...

Pearls and Pitfalls

  • If hemodynamically unstable and life threatening, synchronized cardioversion is warranted

  • Rate or rhythm control is an individualized option for stable atrial fibrillation using β-b...

Additional Reading

  • Chinitz  JS, Halperin  JL, Reddy  VY, et al. Rate or rhythm control for atrial fibrillation: Update and controversies. Am J Med.  2012;125(11):1049–1056.

  • Crandall  MA, Bradley  ...

Codes

ICD9

427.31 Atrial fibrillation 

ICD10

  • I48.0 Paroxysmal atrial fibrillation

  • I48.1 Persistent atrial fibrillation

  • I48.91 Unspecified atrial fibrillation

  • I48.2 Chronic atrial fibrillation

SNOMED

  • 49436004 ...

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