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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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My Heart is Racing! Select Cardiac Arrhythmias and Practice Updates

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lunes, 7 de diciembre de 2015

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Management of atrial fibrillation emergency medicine First10EM
First10EM - December 7, 2015
"Notes
Despite unstable atrial fibrillation being a relatively common problem, information on its management seems (at least based on my review) to be very sparse. Almost every textbook and guideline that I found just states that you should follow the ACLS protocol and electrically cardiovert patients that are unstable. I could not find a single textbook that explored what to do when cardioversion does not work, which seems to be the majority of the time. Understandably, there are also no clinical trials that cover these very sick patients. Therefore, most of the above it based on collated expert opinion and common sense. I cannot support this approach with evidence, but I don’t think that there is any evidence based approach to the dying rapid atrial fibrillation patient. 
The most common alternate management strategy I have encountered focuses on just using fluid boluses to support the pressure while loading amiodarone. There is no evidence that vasopressors help patients, so I can’t argue, but I have a hard time not temporarily making the numbers better while I wait for rate control to occur. Maybe I am treating my own anxiety more than the patient?"
Atrial fibrillation unstable cardiogenic shock algorithm first10em emergency medicine.png

http://first10em.com/2015/12/07/atrial-fibillation/