8/11/2023 0 Comments Cardinal flutter device![]() If you are considering anticoagulation, use the ORBIT score, if available, or the HAS-BLED score if not, to assess the risk of a major bleed, identify (and subsequently manage) modifiable risk factors for bleeding, and flag the ‘high bleeding risk’ patients for early review and follow-up. In all patients, prioritise calculating stroke risk using the CHA 2DS 2-VASc score. Seek senior and/or specialist review this should not delay urgent DC cardioversion.įollow the integrated Atrial fibrillation Better Care (ABC) pathway for holistic management of any patient with AF: A - Anticoagulation/Avoid stroke B - Better symptom management C - Cardiovascular and comorbidity optimisation (including lifestyle changes). ![]() In patients not already on therapeutic anticoagulation, immediately start anticoagulation pre-cardioversion. Call for anaesthetic support to sedate the patient before DC cardioversion. Urgently admit any patient who is haemodynamically compromised to an acute medical unit. Regardless of the duration of onset of the patient’s arrhythmia, do not delay emergency synchronised direct current (DC) cardioversion in the following groups as their condition may be life-threatening: features of haemodynamic instability symptoms of acute myocardial ischaemia suspected or confirmed serious precipitating illness requiring hospital care AF alongside a pre-excitation syndrome such as Wolff-Parkinson-White syndrome signs or symptoms of acute stroke. ![]() Perform manual pulse palpation and conduct an immediate 12-lead ECG. Suspect new-onset AF if the patient has an irregularly irregular pulse with or without any one of: palpitations (the cardinal symptom) dyspnoea chest pain fatigue dizziness polyuria syncope. ![]()
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