Everything you ever do about atrial fibrillation is one of three things: rate control, rhythm control or anticoagulation. Build a patient on the left — risk factors, how long they have been fibrillating, whether the rhythm is making them sick — and watch the CHA2DS2-VASc score, the cardioversion clock and the drug choice resolve on the right. Then audit an adenosine push, because the supraventricular tachycardias next door have their own rules.
Age
Sex
Other CHA2DS2-VASc risk factors
How long has the atrial fibrillation been going?
Is the rhythm making the patient sick right now?
Two facts that change the drug
Different rhythm, different rules — audit an adenosine push
Your patient has a regular, narrow-complex tachycardia at 190, is alert with a blood pressure of 118/70 — stable paroxysmal supraventricular tachycardia. Tick every statement below that describes safe, correct practice. Leave the unsafe ones unticked.
Not audited yet.
Adenosine audit
Tick the safe practices on the left, then press Check my audit. Every item gets a rationale.
Start here, always
For the stable patient, start with vagal manoeuvres: bear down as if having a bowel movement (Valsalva) for 10 to 15 seconds, or a cold stimulus to the face. Have the monitor running and a strip recording — the transient AV block a vagal manoeuvre produces is diagnostic even when it does not convert the rhythm, because it unmasks flutter waves or fibrillation. Carotid sinus massage is a provider manoeuvre and is avoided in older adults and anyone with carotid bruits.