A patient presenting to the emergency room is experiencing atrial flutter. The initial management of atrial flutter in a stable patient with a narrow QRS and regular R-R interval is:
A) Rapid IV administration of adenosine 6 mg, followed by a 20-mL saline flush and elevation of the arm
B) IV administration of a beta-blocker
C) Rapid IV administration of adenosine 12 mg, repeating the drug administration if needed
D) IV administration of magnesium
Ans: A
Feedback: If the patient with atrial flutter is stable, the QRS is narrow, and the R-R interval is regular, 6 mg of adenosine may be rapidly administered followed by a 20-mL saline flush and elevation of the arm. If the rhythm does not convert to sinus rhythm within 1 to 2 minutes, a 12-mg bolus may be administered and repeated, if needed, within 1 to 2 minutes. If the adenosine fails to convert the rhythm or if the R-R interval is irregular, then magnesium, diltiazem, or beta-blockers may be administered.
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