Melissa and Jessica’s A-fib patient

Once upon a time there was an active 22 year old, African American male named Devone who loved playing basketball. His grandpa recently passed away from a pulmonary embolism.   He came into the ER today because he had a syncopal episode during the last quarter of the division finals for his basketball team. The nurse assessed the patient finding an irregular, thready pulse; he is pale and more fatigued than usual after a game, which has been worsening over the last week; his capillary refill is 3-4 second. His 12 lead EKG revealed atrial fibrillation with a heart rate of 140-157 bpm with no p waves.  The nurse began to assist the patient by attempting to stimulate the vagal response by having him blow through a straw which was successful in reducing heart rate to 80 bpm. The nurse also conferred with the physician to determine recommendation of anticoagulation therapy. The nurse also educated the patient on lifestyle modifications and the necessity of follow up appointment. As a result of these actions the patient was discharged with a follow-up appointment with primary physician, and prescription for 325mg of aspirin daily.