3.2 Atrial Fibrillation/Flutter

EMT/ADVANCED EMT STANDING ORDERS

• 1.0 Routine Patient Care

PARAMEDIC STANDING ORDERS

• If the rhythm appears to be amenable, e.g., “regular narrow SVT,” may attempt vagal maneuvers: “Valsalva” and/or cough.

• If the patient’s systolic blood pressure is unstable (less than 100 mm Hg, with signs of hypoperfusion): 

• In Atrial Fibrillation, synchronized cardioversion at 200 J, 300J, and 360 J or the equivalent biphasic values as per manufacturer). 

• In Atrial Flutter, synchronized cardioversion beginning at 50J. 

• Check rhythm and pulse between each attempted cardioversion.

• If Cardioversion is warranted, consider use of 7.6 Sedation and Analgesia for Electrical Therapies.

• Diltiazem HCL 

• Heart rate greater than 150 and patient stable but symptomatic:

• Initial bolus: 0.25 mg/kg slow IV/IO over two (2) minutes.

• If inadequate response after 15 minutes, re-bolus 0.35 mg/kg SLOW IV/IO over two (2) minutes.

          CONTRAINDICATIONS:  Wolff-Parkinson-White Syndrome, second or third degree heart block and sick sinus syndrome (except in the presence of a ventricular pace maker), severe hypotension or cardiogenic shock.

• If patient is already taking a Beta Blocker, Metoprolol as an alternative:  

• Bolus: 2.5-5 mg SLOW IV/IO over 2 minutes.  

• Repeat dosing in 5 minute intervals for a maximum of 15 mg.

• Heart rate less than 150 and patient stable but symptomatic: 

                  Contact Medical Control.

MEDICAL CONTROL MAY ORDER

• Additional doses of above medications.

• Amiodarone 150 mg Slow IV/IO over 10 minutes.

RED FLAG: CAUTION: Do not use IV Metoprolol with IV Ca Blockers.