BUMC Basics.pdf - Anesthesia Home

36
Get 1 point for each and 2 points for stroke or TIA.
0 Points: ASA 325mg q day alone
1 point: ASA 325mg q day or Coumadin (INR 2-3)
2 or greater points: Coumadin (INR 2-3)
Rhythm Control: Electrical or Pharmacologic cardioversion
• Electrical:
- 48 hours, and has been with INR 2.0 to 3.0 for
3 weeks, no need for TEE. If INR not therapeutic,
need IV heparin or SQ lovenox before TEE &
then DC CV
- If LA thrombus, anticoagulate >8 weeks, then
cardiovert
- If pt. is cardioverted and they were in AFIB
greater than 48 hours they will need to be anticoagulated
with Coumadin for at least 4 weeks.
(High likelihood of reoccurrence).
• Pharmacologic choices: Procainamide, ibutilide,
flecainide, propafenone, amiodarone (watch PFT’s,
TFT’s, LFT’s), sotalol (watch QTc), Dofetilide (watch
QTc, no Bblocker effect so good for patients who
can’t tolerate amiodarone or sotalol, but need special
prescribing privileges.)
CALCIUM CHANNEL BLOCKERS
Class/Drug AV
Blockade
Vasodilation BP
Control
Dihydropyridine None +++ +++
Verapamil +++ + +
Diltiazem ++ ++ +
CHEST PAIN
Can be typical, atypical, or non-cardiogenic chest pain.
Assess chest pain — If has chest pain (1 point), if occurs
with exertion (1 point), and relieved with rest or NTG (1 point)