Emergency Cardioversion of Atrial Flutter
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- Опубликовано: 29 сен 2024
- I am in the process of preparing multiple videos to be used without charge by an emergency medicine textbook. This video was revised and shortened several minutes to make it more educationally efficient. I am reposting it because of its educational value and because new subscribers to this channel may not have previously seen this excellent training video.
I got cardioverted for afib a few years ago. Was moderately entertaining.
Thanks for sharing.
It would be nice to add subtitles when other people are speaking. Great video
Thank you!
when you manually turn on captions, they seem to pick up what others are saying in the video great
When I was a teenager, I remember coming out of anesthesia, and I was terrified for years later that I said something rude to the staff. I still remember that moment, and that's when I started to learn about my anxiety. Now, as an old man, I realize I never said anything, and it was all in my mind, and even if I did say something bad, nursing staff would not have cared 5 minutes later.
Exactly right!
Just wondering when you give concious sedation what exactly your checklist , pre requisite and everything you do step by step. Thanks
email me at lmellick@gmail.com. I'll just send you some information via email.@@farhanqadeer82
Why the patient hasn't been preoxigeneting before the procedure?
Definitely an option. Some prefer to be made aware when the patient is hypoventilating.
@@lmellick that doesn't make sense to me. You can simply see when patient is hipoventilating without o2sat. And hypoventilation after propofol is normal. Preoxigenation give you more time if something goes wrong. I'd consider also some analgetic, usually we give also 1mcg of fentanyl per kilo.
Thank you for response, fan from Poland :)
Especially with procedural sedation of children I prefer end tidal CO2 monitoring over giving then oxygen. This specific sedation was overseen by a cardiologist and his nurse. @@grzesiekszajnowski9698
This source explains nicely this question. Thanks!
“Oxygen administration during procedural sedation is used more frequently, since most patients are monitored on capnography. The goal of supplemental oxygen is to increase oxygen reserves, thereby delaying or preventing the onset of hypoxia. However, increasing oxygen reserves through supplemental oxygen is not without risk. Patients who are given supplemental oxygen desaturate only after a prolonged period of apnea. Adults and adolescents who are preoxygenated with 100% FiO2 (fraction of inspired oxygen) and become apneic have around 6 minutes until they desaturate below 90%. In healthy children aged 2 to 12 years, this will decrease to 3 to 4 minutes. Early recognition of respiratory depression is important to help prevent loss of airway reflexes and risk for aspiration. The warning sign for apnea will be detected on capnography first, while the pulse oximeter reading initially remains normal.”
I have SVT, it sure isnt fun.
Bad sound low voice.?
The cardiologist comments were difficult to make louder without making the background noise also louder. Thanks for pointing that out, though.
Very educational thank you Doc! Keep up the good work.
You are welcome!
@@lmellick ♥️
I live with Afib. I had a cardioversion at the end of February last year. I have a Kardia Mobile and check it every week. Friday after Thanksgiving it was back. I really feel nothing different, but the Kardia told me. A message to my electrophysiologist and I'm back getting zapped the next week. I'm on Eloquest full time.
Thanks for sharing!
My Dad's heart rate would get over to 200 sometimes. It would be in a quiver. They would often have to reset his rhythm.
Wow, thanks! Great video. Didn't know that pads location depends on the body habitus
Why not give a mask during induction of anesthesia? Maybe you need to start holding your jaw a little earlier?
I have to get this done because i live with afib. I am so afraid but i know I'll be in good hands.
so she was cardioverted with only propofol and no electrical discharge?
I am in love with this series.
Cool!
Very helpful video
Glad this was helpful.
Awesome video Dr. Mellick🥰
Glad you enjoyed it!
@@lmellick I definitely did! Thank you for the video.
Thanks Doc !
You are welcome!
Very professional setup, like always. Love how you ask the patient and explain it to them.
I just recently learned on a convention, that the it the position of the pads doesn't matter (like if you do it anterior/posterior or in front).
I also found it very interesting in the video, that the patients arms were "fixated" - never saw this, but so smart!
When I see professional videos likes this I miss emergency medicine 😅 But I'm also good with having left Healthcare 😊
Thank you!
Very interesting & informative, thank you.
Glad you enjoyed it!
just stumbled upon this channel researching saturday night palsy for my anatomy class. great stuff!
2 questions, how do the staff clean hands when having watches on their wrist? My thoughts are no rings, bracelet or watches while interacting with patients.
The other thing why so many people and alarms from the monitor constantly throughout the procedure. Alarms are fine but when you are with the patient during a procedure like this it’s so disturbing. Most places I’ve seen there is an anesthesiologist, nurse and cardiologist (some places just a junior doctor with a cardiologist on call). Shouldn’t need a bigger group to sedate, cardiovert and record new ecg afterwards.
Just my thoughts.
Interesting. Havent had a case of Aflutter needing electrical cardioversion. Usually Amio does the trick by the time it evolves into a grossly rapid afib.
amiodarone is not a drug of choice fot pharmacological cardioversion...
"When do I start burning?" is the same question I get from my steaks when I use my BBQ grill. :) Nice video, monsieur.
Hah, thanks!
Why cardiovert instead of dilt for this patient? She seemed stable
This was revision of an earlier video, so I don't remember exactly why we didn't use dilt. It may have had to do with going for ablation the next day.
Your channel is added to my mind Great information , thx from 🇮🇶
Welcome!
Do you routinely use capnography? our area never uses for critical intubated patients, we transfer patients sometimes with end tidals of 70-80, I’m thinking they rely more on blood gases
Also say oxygen saturations stayed low would you ever intubate then remove after sedation wears off ER
No, we would just bag valve mask a few puffs and they get better.
When Dr. Berman mentioned asking when the patient ate or drank last, is that solely due to the use of propofol? what would be an acceptable vs unacceptable time of last meal/drink? and following this, if the timing is unacceptable, does this become an awake cardioversion with no use of sedation?
There is some tension between inpatient and anesthesia services recommendations for preprocedural fasting requirements versus emergency medicine perspective. Dr. Berman, the cardiologist, was calling the shots and would probably have used the more conservative procedural sedation recommendations of anesthesia (regarding fasting). "There have been numerous studies regarding preprocedural fasting for PSA, and none have demonstrated increased rates of serious adverse events with decreased fasting times."
To respond to the last question: No, it would mean a delay of at least several hours before the procedure would be done.
Amazing!!!!
Thanks!!
I have an extensive and complicated cardiac history. Dr. Irwin has done 7 EP studies with multiple ablations on me since 1992 when I was 20. I had an experimental procedure back in 1997 where I had multiple ablations, 36 during that procedure alone. I’ve had a pacemaker since I was 25 and my first bout with CHF was in 1998. My SA node was 3X the size of normal and my resting rate was 120-130. I eventually developed A-Fib and had to start warfarin. I’ve got an extensive medical history in and of itself too so it’s been a rough ride. The AF became more of a problem in 2007 when my EF dropped to 25% if I remember correctly, I was in the hospital constantly for that or my latex allergy. I get anaphylactic shock from minute exposure. I got a little better with the CHF meds and was able to hold off on the PVI with cryoablation until 12/2011. That was a rough procedure and I had an anaphylactic reaction while there but it did fix my AF issue. Still have my other cardiac rhythm problems and the other issues but no more AF.
Wow! Thanks for sharing.
cardiovert from one arrhythmia into another? oh lord
What are you talking about?? She went back into a NSR!
@@bettysmith4527 he's saying it's a potential complication, not that it happened to her
you guys are awesome, just awesome!