Sunday, February 10, 2019

RACE protocol in Atrial fibrillation.

Hello! This is a short post regarding RACE protocol. Before starting it, here are some high yielding points regarding Atrial fibrillation.

Most common cause of embolic stroke: Non rheumatic Atrial fibrillation.
Examination shows
1) Pulse: Fast
2) Rhythm: Irregular
3) Pulse deficit more than 10/ min is diagnostic of Atrial fibrillation.

Ecg finding:

1) No P wave
2) R-R interval keep varying

R. A. C. E. protocol is followed in treatment of the Atrial fibrillation.

1) Rate control :

Short acting beta blockers are given to decrease heart rate. Decreasing heart rate leads to increase filling time of the heart. This in turn leads to increase diastolic time. It Increases end diastolic volume, stroke volume, cardiac output and increase BP.

Beta blockers used: Intravenous Esmolol or Verapamil.

2)Anticoagulation:

Atrial fibrillation causes increase clot formation in heart. Clots can be detected by Transesophageal Echo.
Oral Dabigatran and Rivoroxaban given as a treatment. Earlier Warfarin was used but it is not used now due to tendency to form intracranial hemorrhage.

3) Rhythm control:

Intravenous Ibutilide (Class 3 antiarrythmic drug) given to control rhythm.
Chemicals cardioversion is drugs used to terminate ectopic foci.

4) Electrical cardioversion:

If chemical cardioversion fail, go for electrical cardioversion. In this technique patient is sedated with i.v. Propofol and DC shock of 200J biphasic is given.

That's it!

-Demotional bloke

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