new onset afib that converts

[EMFreakz]

Do you all routinely still admit these guys if they've converted? What's your criteria for admission if they've converted?

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[leorl]

sure i admit, whether they spontaneously converted or whether i converted them. new onset paraoxysmal afib is still something that has to be worked up and observed - tele/holter/echo for at least 24 hrs, esp as it has the potential to go unstable or create dangerous symptoms. It's also an ACS workup.

 

[takotsubo]

i've sent home patients before for followup...whether i cardioverted them or if they slowed down on their own. It depends on the clinical situation, older people i'll keep and work up.

 

[uncwalley]

I always have, however, I'm starting to rethink this. There is literature to suggest it is safe for a certain subset to go home, whether you convert or they convert on their own. Usually, they have some complicating factor that makes me admit. We'll see how it goes when the next young, otherwise healthy heart that I see in A.fib comes in.

 

[deleted109597]

This isn't Canada. It might be safe to send 99% of those patients home, but until we get some meaningful malpractice reform, it isn't fiscally sound.
I personally would like to send them home though.

 

[takotsubo]

What about SVT patients?

 

[Rendar5]

Had one yesterday, but he also had syncopized twice before coming in. Not someone to send home. He agreed to stay overnight so we could make sure he stayed in sinus. Rest of his workup is going to be outpt.

 

[yahoomail]

What about SVT patients?

New onset ones I'd admit for cardiac workup, the ones with known diagnosis of SVT go home if labs normal and no abnormal activity on monitor for 6 hrs in ED.

 

[takotsubo]

New onset ones I'd admit for cardiac workup, the ones with known diagnosis of SVT go home if labs normal and no abnormal activity on monitor for 6 hrs in ED.

I could never keep a pt in my ED for 6 hours. Wow.

 

[Arcan57]

What about SVT patients?

Convert, check lytes and TSH. Follow up with cards on outpt. basis.

 

[EMRAGE]

Convert, check lytes and TSH. Follow up with cards on outpt. basis.

Agree, with addition of calling cards to inform and ask opinion on DISPO... and document everything.

RAGE

 

[pinipig523]

I always have, however, I'm starting to rethink this. There is literature to suggest it is safe for a certain subset to go home, whether you convert or they convert on their own. Usually, they have some complicating factor that makes me admit. We'll see how it goes when the next young, otherwise healthy heart that I see in A.fib comes in.

That's in Canada.

I still don't think it's safe.