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- Jul 1, 2016
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I'd like to get a sense of your common aggravations with the emergency department and their management of cardiac conditions. What do you see commonly that you wish they would do differently, what do you see that you think is well done (or even above and beyond) regarding what you would expect, and what do you see that is downright dangerous?
I think I'll add specific questions to this thread later on as they come to me, but for now:
1) What is your opinion on electrical cardioversion of a-fib with rvr, stable, no chest pain in a patient who has known a-fib that is well controlled for years on b-blockers until ~10 hour episode. Would you agree with sedation and synch cardioversion or would you prefer the ED use pharm? Also, where do you land on anticoagulation for a patient like this assuming they are returned to NSR and discharged from ED with cardio follow up within 3-5 days (assuming they are not on anticoagulation or maybe just Aspirin?
2) I have sat in many IM rounds where the troponin ordered in the ED is ridiculed heavily. Some ED docs will reflexively order the trop with any patient with CP (though I might disagree), but in a patient with a-fib + rvr, or brady with chest pains would a trop not be wise?
Thank you for your insight. I'll ask lots of dumb questions around these forums I think. Seems like a good resource.
I think I'll add specific questions to this thread later on as they come to me, but for now:
1) What is your opinion on electrical cardioversion of a-fib with rvr, stable, no chest pain in a patient who has known a-fib that is well controlled for years on b-blockers until ~10 hour episode. Would you agree with sedation and synch cardioversion or would you prefer the ED use pharm? Also, where do you land on anticoagulation for a patient like this assuming they are returned to NSR and discharged from ED with cardio follow up within 3-5 days (assuming they are not on anticoagulation or maybe just Aspirin?
2) I have sat in many IM rounds where the troponin ordered in the ED is ridiculed heavily. Some ED docs will reflexively order the trop with any patient with CP (though I might disagree), but in a patient with a-fib + rvr, or brady with chest pains would a trop not be wise?
Thank you for your insight. I'll ask lots of dumb questions around these forums I think. Seems like a good resource.