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Urgent Care

Given the current shortage of Diltiazem: In cases of rapid atrial fibrillation that require rate control per protocol, please consider there is a standing order to use Metoprolol instead. Dosing is 2.5-5 mg per protocol, often the 5 mg is the most appropriate dose.

Note that rate control per protocolis only appropriate when:

1) rates are above 150

2) patients are symptomatic from this (but also stable; unstable patients get cardioverted)

Protocol does not specify this, but please remember that rate control (with either diltiazem or metoprolol) is not first-line for patients who have rapid heart rates from an obvious underlying cause– for example a patient having a large GI bleed, or a fever/sepsis picture. In those patients, the heart rate is actually compensating for a problem, and blocking the AV node is potentially harmful.

Protocol also mentions Amiodarone as a med control call option for rapid AFib. It should remain a med control call option only.