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Clinical Protocols

Evidence-based, practice-specific protocols authored by Dr. Rasch — designed for use by mid-level providers at the point of care.

4
Active Protocols
Mar 2026
Last Updated
Dr. Rasch
Author, DO
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Protocol #001 New-Onset Atrial Fibrillation Arrhythmia · 11 Steps Protocol #002 Hyperlipidemia Management Lipids · 11 Steps Protocol #003 Hypertension Management Hypertension · 10 Steps Protocol #004 Palpitations Workup Arrhythmia · Workup · 6 Steps

Active Protocols

4 protocols · Last reviewed March 2026
#001 Arrhythmia
New-Onset Atrial Fibrillation
Complete management protocol from initial diagnosis through anticoagulation decision, MCOT monitoring, and TEE-guided DCCV for persistent AFib. Includes interactive CHA₂DS₂-VASc calculator.
Eliquis preferred OAC · MCOT for burden quantification
TEE/DCCV at Scripps Prebys · Scheduled via Nancy
AFib OAC DCCV Rate Control MCOT
Updated March 2026 · v2.0 Open Protocol
#002 Lipid Management
Hyperlipidemia Management
Risk-based, treat-to-target lipid management. Covers statin hesitancy strategies for the Encinitas patient population, Lp(a) as LDL's "evil twin cousin," and PCSK9 inhibition including Leqvio in Medicare patients.
Pitavastatin 4mg for hesitant patients · Nexlizet low-bar
Leqvio via Livewell Del Mar · Medicare preferred pathway
LDL Targets Statins Lp(a) PCSK9i Leqvio
Updated March 2026 · v1.0 Open Protocol
#003 Hypertension
Hypertension Management
Stepwise antihypertensive therapy with clear agent preferences. Valsartan first-line. OSA screening protocol. Echo-guided identification of end-organ damage. Entresto off-label for resistant HTN and diastolic dysfunction.
Valsartan → Amlodipine → Aldo antagonists → Thiazides
OSA → Dr. Andrew Hsing · RBPM for white coat HTN
Valsartan Resistant HTN OSA Echo Entresto
Updated March 2026 · v1.0 Open Protocol
#004 Workup Arrhythmia
Palpitations — New Complaint Workup
Structured evaluation for every new palpitation complaint. Includes EKG pattern reference illustrations (WPW, Brugada, AV block, AFib, SVT, PVC), MCOT ordering guidance, and management by rhythm diagnosis.
EKG + MCOT + Echo required every new complaint
Urgent EP referral → Dr. Hamzei for AV block / WPW
PAC/PVC SVT AFib AV Block EKG
Updated March 2026 · v1.0 Open Protocol

In Development

Planned protocols
Arrhythmia
Heart Failure — HFrEF & HFpEF
Coming Soon
Workup
Chest Pain — Outpatient Evaluation
Coming Soon
Arrhythmia
Syncope — Workup & Risk Stratification
Coming Soon
Medications
Anticoagulation Reference
Coming Soon
Metabolic
Diabetes & Cardiometabolic Risk
Coming Soon
Procedures
Pre-Procedure Checklist
Coming Soon