A fib tx algorithm
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Dr. Bhan provides guidelines for managing atrial fibrillation (A.Fib) based on the time of onset of symptoms and whether spontaneous resolution occurs. For onset within 24 hours, chemical or electrical cardioversion is recommended if spontaneous resolution does not occur, along with 4 weeks of anticoagulation. For onset over 24 hours, patients should be anticoagulated and either admitted or treated with rate control medications if asymptomatic, along with long-term anticoagulation.
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Diabetic ketoacidosis ppt
A 55-year-old male presented with pain and swelling in his left foot and lower leg along with abdominal pain and drowsiness. Examination revealed tachycardia, hypotension, tachypnea, and abdominal tenderness. Laboratory findings were consistent with diabetic ketoacidosis (DKA): hyperglycemia, ketonemia, and metabolic acidosis. The patient was diagnosed with DKA likely precipitated by infection and treated with insulin, intravenous fluids, potassium supplementation, and monitoring of electrolytes and glucose levels.
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4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
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A fib tx algorithm
- 1. Dr. Bhan’s Suggested Guidelines for Management of A.Fib Urgent cardioversion should be undertaken for any patient with… Active ischemia (symptomatic or ECG-evidence) Evidence of organ hypoperfusion Severe manifestations of heart failure Presence of a pre-excitation syndrome Time of onset Spont resolution? Dispo? Anticoag? <24h Yes Home ASA only <24h No Home 4 weeks* Chemical or electrical CV is indicated 1. Chemical: Ibutalide+Mag (in combo) for all-comers Flecainide+βblocker (in combo) for pt<40yo 2. Electrical: Paddles in A/P orientation (see video) Sedate and give 100mV biphasic (up to 200) >24h Yes Home 4 weeks* >24h No Depends Yes If pt is symptomatic anticoagulate and admit If pt is asymptomatic anticoagulate and rate control o Medication regimen for rate control… 1. Bolus dose Cardizem 0.25mg/kg and send home on low- dose βblocker (metoprolol XL 25mg QD) 2. If pt is hypertensive at time of discharge, add ACE-I or ARB to regimen (10mg QD) a. ACE-I actually has been shown to decrease the incidence of electrical remodeling in converted AF pts and possibly prolong the incidence of recurrence ***Caveat: Dr. Bhan recommends that 24h be the cutoff timeframe for symptom onset and due credence and respect is given to this informed opinion. Current AHA guidelines and multiple studies confirm that 48h is an appropriate cutoff.*** *4 weeks of anticoagulation: Dabigatran or lovenox/heparin