Asymptomatic A-Fib HR 130-150

let me preface this with the fact that im a medic student right now so some of my ALS knowledge may be off a bit...but maybe some of the ALS people can give some opinions...

Heres the scenario..

called out for a early 70s y/o F, with a cc of CP 5/10. She states it feels like her heart is "beating out of her chest". We are first on scene as a bls rescue, do an initial assessment, put her on high flow o2. First set of vitals are 124/88, 138IRR,18NL,WPD,PERRL. She states she has had 7 stents,HTN,DM,and COPD. She states she took an Albuterol treatment and a NTG tab approx 30-40 min prior to our arrival. She states the CP is now gone after admin of o2. ALS arrives and does a 3 and 12 lead ekg. 12 Lead shows A-FIB @ 130-152 with LBBB. Pt is asymptomatic at time of transport,ALS sets up Cardizem drip for transport. My question out of all of this,in a pt with an extensive cardiac Hx like her, would any of you had the pt Vagal down to try and get her to convert or would you have gone with the cardizem, or just provided supportive care/als monitoring to the hospital (6-7 min transport time). Discuss.

With the extensive Cardiac hx I believe that the Cardizem is probably a good call. Always difficult to say whether something would have worked or not. My question is more, do you want to convert this asymptomatic patient in the field or leave that treatment to the hospital...just for the potential of the patient throwing a blood clot after the conversion.

The key ingredient missing from this equation is med history. Allot of geriatric Pt's live on a daily basis with A-fib. That being said one of the complications of chronic A-fib is blood pooling in the atrium and creating clots which can be dislodged becoming an emboli. That is why Chronic A-fibbers are on coumadinetc to prevent clotting. Cardizem is indicated in new onset A-fib only. If you administer it to a chronic A-fibber (potentially knocking out he A-fib and creating a temporary sinus rythm) you can throw clots causing a stroke. I would have witheld cardizem and stayed with supportive care and CP protocol. JMO