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Atrial flutter

  • Tx

    • if unstable, give cardioversion 50-100J
    • rate control:
      • diltiazem 20 mg IV over 2 min followed by 5-15 mg/h. If no response after 15 min, give second dose 25 mg.
      • if EF < 40%, use amiodarone 5 mg/kg IV over 30 min followed by 1200 mg over 24 hr.
    • anticoagulate if > 48 hrs: heparin 80 U/kg IV followed by 18 U/kg/h IV
    • long term anticoagulation:
      • daily aspirin if CHADS2 = 0
      • warfarin if CHADS 2 > 1
      • pt preference if CHADS2 = 1
    • other:
      • r/o atrial thrombus with TEE before cardioversion
  • ROS CHADS2 score

    • 1 point each:
      • CHF
      • HTN
      • Age > 75
      • DM
    • 2 points if PMH stroke, TIA, PE, or DVT
  • EKG

    • tachycardia, sawtooth baseline

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    Disclaimer: MDHero Workups is for educational use only, and is not meant to replace the clinical judgement of a professional. We do not guarantee the accuracy of any information on this website.