How Do You Manage Unstable Atrial Fibrillation in Emergency Medicine and Critical Care?
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- Опубліковано 5 сер 2024
- In this video, Sara Crager discusses the management of Unstable A-Fib (Atrial Fibrillation). She highlights the importance of distinguishing between primary and secondary causes of instability before considering immediate cardioversion. Sara emphasizes that not all patients with A-Fib and low blood pressure require immediate intervention. Factors such as fluid status, electrolyte levels, and sympathetic activity should be evaluated to determine the underlying cause of instability. Sara advocates for a comprehensive approach that goes beyond the choice between beta blockers and calcium channel blockers. She introduces seven key questions to guide the management of Unstable A-Fib, including primary versus secondary causes, rate versus rhythm issues, the necessity of immediate cardioversion, electrolyte correction, fluid status assessment, and the use of appropriate medications. Sara suggests considering Amiodarone as a go-to option for rate and rhythm control in unstable A-Fib cases, while also addressing blood pressure support with medications like phenylephrine or vasopressin. Overall, this video provides valuable insights and strategies for effectively managing Unstable A-Fib.
00:04 Introduction to Unstable A-Fib
00:24 Understanding the Complexity of A-Fib
01:01 Broadening the Approach to A-Fib Treatment
01:47 Seven Questions to Guide A-Fib Treatment
01:59 Primary vs Secondary A-Fib
03:14 Case Study: Misdiagnosed A-Fib
04:03 Understanding the Role of Heart Rate in A-Fib
04:37 The Impact of Rhythm in A-Fib
07:06 The Role of Stress and Sympathetic Response in A-Fib
09:40 Importance of Correcting Electrolytes in A-Fib Treatment
10:57 Addressing Fluid Status in A-Fib Patients
11:56 Choosing the Right Drugs for A-Fib Treatment
14:13 Conclusion: A Comprehensive Approach to Unstable A-Fib
Check out www.resusx.com for education on resuscitation
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Thank you Dr. Crager. You are the intensivist we all aspire to be!
Fantastic!
She is amazing, on the top of emergency world educators.. thank you very much
You’re so very welcome!
Great lecture Dr Crager
Wished you had a pod cast of yr own
You make any topic interesting and easy to understand instead of reading the boring books🙏
Thanks for the comment!
Though you can learn all these in books and other resources, this video puts all the information in context. And I love it. Thanks for this ❤
You’re welcome. Glad it was helpful
Great lecture. Why esmolol instead of Metoprolol?
Thank you for all valuable information! ❤️
You are so welcome!
Thank you very much
You’re so welcome!
Dr. Crager--I love the Precedex for A-Fib concept, wow! An additional bonus would be your fluid overloaded pt. benefitting from high dose Precedex's diuretic effects. What dose do you recommend starting these pts. at?
Thank you to Dr. Crager for a fantastic lecture as only she can deliver. I'd love a "Crager Questions" style segment where she tackles the HALO pts. & gives us her signature critical thinking/gestalt breakdown questions...can we make this happen?!
I’ll ask her! Thanks for your comment
Hi.
Great lecture as always. Thanks to Dr. Cragger.
My question is in the case of heart failure or SCAPE, how do you know if the A fib is the cause or not? ( imagine you don't know the previous history)
I work as an emergency physician in prehospital setting in Eurpoe.
Thanks a lot
What about anti-coagulation prior cardioversion?!
For stable or unstable patients?