March 10, 2023

How Best to Perform Electrical Cardioversion - Part 3 of 7

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- Welcome to MicroED, quick facts for big issues. My name is Salim Rezaie, a Community ER Doc in San Antonio, Texas. For Part 3, we're gonna be discussing how best to perform electrical cardioversion. Now, I wanna start off by saying that this is safe and effective. There's a higher success rate with this than there is with pharmacologic cardioversion. In patients who present with atrial fibrillation and flutter and present in less than or equal to 48 hours, these would be the patients we wanna consider this in. Now, the one thing we fear is thromboembolic events from doing the electrical cardioversion. And the literature tells us that, in patients who've had less than 48 hours of symptoms, the chance of this happening is less than 1%, especially if patients are already anticoagulated, which many of these patients are. We'll get into anticoagulation in Part 7. Now, there's three specific things in terms of how to do this procedure best. Number one is, you wanna make sure you're giving your patients procedural sedation and analgesia. This could be things like IV propofol or IV fentanyl. You definitely don't want your patient awake while you're doing this. You wanna place your pads in an anterior posterior pattern as opposed to an anterolateral pattern. There appears to be based on the literature a higher success rate with this. And then finally, we wanna use a biphasic synchronized non-escalating energy of 200 joules. 200 joules, 200 joules, 200 joules. We don't wanna escalate the dose because we want our best shot to be our first shot. Thank you for listening, and stay tuned for Part 4, where we'll discuss options for chemical cardioversion.

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