• Assess ABCs
• Secure airway
• Administer oxygen
• Start IV Attach monitor, pulse oximeter, and automatic B/P cuff
• Assess vital signs
• Review history
• Perform problem focused physical examination
• Order 12-lead ECG
• Order portable chest x-ray
• Control rate first with calcium channel blocker or beta blocker
• To convert rhythm: consider DC cardioversion. May use 1 of the following agents: Amiodarone, Ibutilide, Flecainide, Propafenone, or Procainamide.
• If WPW is present avoid adenosine, beta blockers, calcium channel blockers, and digoxin. Preferred drugs are Amiodarone or Procainamide.
• If Afib/Aflutter has been present for more than 48 hours use agents with potential to cardiovert with extreme caution due to the risk of embolic complications. Avoid nonemergent cardioversion when afib/aflutter has been present for more than 48 hours unless anticoagulation or clot precautions are taken.

To: ACLS Intravenous Medicated Infusions