* ABCs                                                           * Assess Vital Signs
* Secure Airway                                              * Review History
* Administer Oxygen                                       * Physical Examination
* Start IV                                                         *  Order 12 leads
* Cardiac Monitor , Pulse Oximeter                 * Portable Chest X - Ray

Observation

Consider the following causes:
* Pulmonary Embolism
* Electrolyte Abnormalities
* Hypoxia
* Acute Myocardial Infarction
* Medication Toxicity
  (particularly Digoxin
   or Quinidine)

Sedation *

Slow the Ventricular Response

Vagal Maneuver may serve a
diagnostic purpose in A. Flutter

Consider:
* Diltiazem
* Digoxin
* Beta Blockers  
   (Caution after  
   Verapamil)

After 15-30 min

Max. total dose of 20 mg

Chemical Conversion

Maintenance : 2-3 mg/min
Max. total dose  of 17mg/kg.

Anticoagulant Therapy

Carotid sinus pressure is contraindicated in patients with carotid bruits ; Avoid ice
water immersion in patients with Ischemic Heard Disease.

Premedicate - Effective regiments have included a sedative (eg, Diazepam ,
Midazolam , Barbiturates , Etomidate , Ketamin , Methohexital) with or without
analgestic agent (eg , Fentanyl , Morphine , Meperidine). Many experts
recommend anasthesia.

back

AHA ; ACLS ; 1994 ; 1-32  -  1-36

Paramedic Neomi Zvi - Feb. 2000