BH ICU Manual
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Atrial Fibrillation

Suggested approach and Clinical Pearls
  • Assess for shock state and extended therapy in critical care environment
  • Determine need for electrical or chemical reversion and telemetry​
  • Consider additional causes for atrial fibrillation
    • New or worsening cardiovascular status, new or worsening sepsis, electrolyte or endocrine abnormalities, inadequate usual medication
  • Determine if atrial fibrillation is new or old
    • New AF – aim for cardioversion in 1st 48 hours with echocardiography and anticoagulation – facilitated by general medicine and / or cardiology
    • Old AF – aim for rate control primarily, with rhythm control as a secondary goal
  • Determine location of care – ward, CCU or ICU
    • ICU 
      • haemodynamically unstable AF
      • AF needing amiodarone infusion in patient less than 3 days post-operatively with no surgical complications (Cardiology should not care for these patients in CCU)
    • CCU
      • Stable AF in patients without immediate post-operative issues who will receive amiodarone infusion
    • Ward
      • Stable     AND
      • Intermittent amiodarone OR
      • Rhythm control only
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