Atrial Fibrillation (Deep Dive R30)
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 15 February 2022
⏱️ 18 minutes
🧾️ Download transcript
Summary
AFib with Rapid Ventricular Rate (RVR) – Rate >110
Primary AFib – Patients symptoms or their hemodynamic instability is due to the AFib itself. Treatment is by rate or rhythm control.
Secondary AFib – Patients AFib rate or their hemodynamic instability is due to an underlying secondary process (eg thyrotoxicosis, PE, sepsis, drugs, etc). Treatment is by treating the underlying process.
Unstable Primary AFib – The presence of hypotension, altered mental status, or pulmonary edema. Treatment is immediate cardioversion, second line agents include digoxin or amiodarone.
Stable Primary AFib (<48 hours duration ) – Treatment is by cardioversion in the ED
Stable Primary AFib ( >48hours or unknown duration) – Treatment is by rate control by CCB (diltiazem or verapimil), or by BB (metoprolol or esmolol)
Anticoagulation – Calculate CHADS2VASC and HASBLED score. Weigh risk of stroke versus risk of major bleeding prior to starting anticoagulation
Further Reading:
Atrial Fibrillation (EMCrit)
Atrial Fibrillation (ACEP Guidelines)
CHADS2VASC Score (MD Calc)
HASBLED Score (MD Calc)
Transcript
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| 0:00.0 | Hello, students. My name is Mike Estefan, and I thank you for joining me today on this month's |
| 0:05.9 | episode of the EM Clerkship Podcast. Buckle up friends, because this month we're going to be talking about |
| 0:12.5 | atrial fiprelation. Before we begin, I would like to share a quick word from our sponsors from the |
| 0:18.2 | folks over at Pearson Ravits Insurance. |
| 0:21.4 | I cannot stress how important it is for you to get disability insurance when you are a resident. |
| 0:28.6 | As a resident, you will see rates lower than at any point in your career. |
| 0:33.4 | Stephanie Pearson and her team at Pearson Ravits have years of experience helping physicians |
| 0:38.6 | like you and I obtain disability insurance. One of the reasons that Stephanie started her company |
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| 0:49.9 | Don't wait until it's too late. Please check out PearsonRavits at www.personravits.com and schedule a consultation appointment |
| 0:59.3 | today. |
| 1:00.3 | Now, back to our episode. |
| 1:02.8 | So atrial fibrillation in the ED can actually get kind of complex. |
| 1:07.3 | It's one of my favorite topics, and so I apologize in advance if I go into a little too much detail, but I'm super excited to give this talk. |
| 1:15.1 | Be sure to give it a second listen if you need to, to let this information sit and absorb. |
| 1:19.7 | I'm going to start with a quick overview covering the basics, and then we will deep dive. |
| 1:23.7 | So let's begin. |
| 1:24.6 | Aphib is defined as an irregularly irregular rhythm without P-waves on EKG, and it's usually |
| 1:31.4 | narrow complex, but in some weird situations, it can become wide complex. |
| 1:36.8 | People with AFIB most often present with symptoms directly due to the AFIB itself, |
| 1:41.7 | such as chest pain, shortness of breath, palpitations, lightheadedness, |
| 1:45.2 | dizziness, etc. |
... |
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