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Atrial Fibrillation Case Study

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Atrial Fibrillation Case Study
Introduction:
This case study discusses the management of a 68 year old male who presented with chest palpitations secondary to rapid atrial fibrillation. Atrial fibrillation is a common cardiac arrhythmia with serious complications if not treated correctly. This essay will discuss the initial clinical presentation of the patient and examine the management and outcome of the interventions applied. The significance of atrial fibrillation including its pathophysiology and aetiology will also be discussed.

Description of the case:
A 68 year old male presented to the emergency department at 0800 hours via ambulance after experiencing chest discomfort and intermittent palpitations since 0500 hours. Prior to presentation, the patient stated he was fit and well, taking only aspirin and Sotolol daily to manage his atrial fibrillation which had been diagnosed in late 2004. The patient had no other medical history and was managed by his local doctor.
Based on the Australasian Triage Scale a category three (urgent) was allocated indicating that the patient should be reviewed by a medical officer within thirty minutes (McCallum, 2006). Due to his rapid heart rate and potential risk of becoming hemodynamically unstable as well as the associated chest discomfort/palpitations he was allocated to the high dependency area within the department.
On initial assessment the patient was gauged as lethargic but orientated, with a Glasgow Coma Scale of 15/15. He was spontaneously breathing, speaking in short sentences, not visibly distressed but moderately short of breath. His skin was warm but sweaty and heart rate irregular on radial palpation. The patient complained of intermittent chest palpitations, similar to previous episodes of rapid atrial fibrillation but denied chest pain. Chest auscultation revealed equal air entry with normal breath sounds. He was not experiencing any dizziness or nausea at the time of assessment. The initial vital signs were as follows: heart rate (HR)



References: Blaauw, Y., Gelder, I. C., Crijns, H. J. (2002). Treatment of atrial fibrillation. Heart, 88 (4), 432 – 437. Bryant, B., Knights, K., & Salerno, E. (2003). Pharmacology for health professionals. N.S.W: Mosby. Huszar, R. (2002). Basic dysrhythmias: interpretation and management (3rd ed.). U.S.A: Mosby. Khairy, P., Nattel, S. (2002). New insights into the mechanisms and management of atrial fibrillation. Canadian Medical Association Journal, 176 (9), 1012 – 1020. Lee, G. (2006). A review of the literature on atrial fibrillation: rate reversion or control? Journal Of Clinical Nursing, 16, 77 – 83. Markides, V., Schilling, R.J. (2003). Atrial fibrillation: classification, pathophysiology, mechanisms and drug treatment. Heart, 89(8), 939 – 944. McCallum, T. (2006). The clinical practice of emergency department triage: application of the Australasian triage scale- an extended literature review. Australasian Emergency Nursing Journal, 9(4), 155 162. Siddoway, L. A. (2003). Amoidarone: guidelines for use and monitoring. American Family Physician, 68(11), 2189 – 2197. Staunton, P., Whyburn, B. (2002). Nursing and the law (4th ed.). Australia: Churchill Livingstone. Tintinalli, J. E., Kelen, G. K., Stapczynski, J., S. (2004). Emergency medicine: a comprehensive study guide. U.S.A: McGraw Hill. Tortora, G., Derrickson, B. (2006). Principles of anatomy and physiology (11th ed.). U.S.A: Wiley.

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