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Rebellion in EM 2019: 3 Things That Have Changed the Way I Intubate

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viernes, 17 de mayo de 2019

Cardiovert AF in the ED

St Emlyn’s - By Simon Carley - May 11, 2019
"If I develop AF then I reckon I’d be able to spot it pretty quick, and I’d get myself down to ED pronto so that I could get myself cardioverted having read the excellent work of Stiell et al​1​. Why? Well I quite like to do cardioversions and so it would be nice to give someone else the opportunity, but more than that, it’s because I think it’s a good idea. But is it?
My belief is that the risks of cardioversion are low, and that the risks of complications are higher if we wait to get it done. In other words my ‘belief’ is that earlier is better, but in truth that may not be the case. The data that’s out there suggests that cardioversion is low risk up until 48 hours​2​ and so what’s the rush? Perhaps it’s because of this thought…..
The bottom line
  • In patients who present to the ED within 48 hours there is probably no panic to cardiovert the patient. It’s fine to delay DC cardioversion to try a period of either rate control, or (as we will continue to do) an attempt to pharmacologically cardiovert them.
  • If you want to go straight for a DC cardioversion then that’s probably also fine, but just make sure you balance the risks of the procedure against time, space and convenience."