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  #1  
Old 06-14-2012
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ER afib more than 48 hours + unstable patient ... next step ?

what is next step in management ?

cardioversion or TEE[ to rule out atrial thrombus]
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  #2  
Old 06-14-2012
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-un stable=hypotensive confused,dying pt u don't have to wait for any thing.
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Old 06-14-2012
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first TEE and then cardioversion...
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Old 06-14-2012
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cardioversion
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Old 06-15-2012
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1 for TEE 2 for cardioversion

whats answer? any source quotes ?
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Old 06-15-2012
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Must do echo in patients with AF>48 hours who are not anticoagulated to exclude the presence of atrial thrombus and allow safe cardioversion.
--harrisons principles of internal medicine. Volume2
16th edition page 1345
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Old 08-24-2013
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Quote:
Originally Posted by um aala View Post
-un stable=hypotensive confused,dying pt u don't have to wait for any thing.
I'm leaning towards this as the right answer.
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Old 08-24-2013
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Quote:
Originally Posted by mbbs2010 View Post
Must do echo in patients with AF>48 hours who are not anticoagulated to exclude the presence of atrial thrombus and allow safe cardioversion.
--harrisons principles of internal medicine. Volume2
16th edition page 1345
Nevermind, i stand corrected.
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Old 08-24-2013
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Quote:
Originally Posted by tyagee View Post
what is next step in management ?

cardioversion or TEE[ to rule out atrial thrombus]
Unstable = about to be dead. Cardioversion first, period. Who cares if there's a beautiful painting painted on the wall.

If you vote for TEE first, when you have an AFib we'll throw a scope down your throat and then restore your blood flow whenever we get around to it... yeah, I didn't think you would want that.

And pulseless AFib (PEA) --> CPR first (not cardioversion.)
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Old 08-24-2013
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Quote:
Originally Posted by mbbs2010 View Post
Must do echo in patients with AF>48 hours who are not anticoagulated to exclude the presence of atrial thrombus and allow safe cardioversion.
--harrisons principles of internal medicine. Volume2
16th edition page 1345

No you don't stand corrected.

That IS CORRECT but ONLY in a stable patient. In an unstable patient you do immediate cardioversion.
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  #11  
Old 08-24-2013
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Unstable patient - Immediate cardioversion

Stable patient - TEE --> (1) Thrombus - Anticoagulation for 3 weeks (2) No thrombus - Cardioversion
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  #12  
Old 08-25-2013
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unstable = shock

YOU dont have time to see if has a thrombus!! SHOCK!!
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  #13  
Old 08-28-2013
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Quote:
Originally Posted by je355804 View Post
No you don't stand corrected.

That IS CORRECT but ONLY in a stable patient. In an unstable patient you do immediate cardioversion.


Quote:
Originally Posted by abcxyz View Post
Unstable patient - Immediate cardioversion

Stable patient - TEE --> (1) Thrombus - Anticoagulation for 3 weeks (2) No thrombus - Cardioversion

Quote:
Originally Posted by target250 View Post
unstable = shock

YOU dont have time to see if has a thrombus!! SHOCK!!
Thanks for the help, appreciate it!
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