March 10, 2023

Rate Control Strategies - Part 5 of 7

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- [Salim] Welcome to MicroED, quick facts for big issues. My name is Salim Rezaie, Community ER doc in San Antonio, Texas. This is part five of a seven part series on atrial fibrillation, where we're specifically gonna be talking about rate control strategies. Now, I know people fall into different camps, beta blocker versus calcium channel blocker, but there's no evidence that suggests one is more effective than the other. Instead, what you're gonna be looking at, is what does the patient in front of you have that will maybe make you not use an agent? For example, in patients who have acute heart failure and asthma, maybe we won't use beta blockers, whereas patients who have acute heart failure with a reduced ejection fraction, maybe we won't use non-dihydropyridine calcium channel blockers. There's lots of options in these two categories. The most common ones used for beta blockers are gonna be metoprolol and esmolol. For your non-dihydropyridine calcium channel blockers, it's gonna be diltiazem and verapamil. Another option, often forgotten, is amiodarone, probably wanna avoid this in thyroid disease. Another option that we don't commonly use in the emergency department, is digoxin, this should probably be avoided in acute and chronic kidney disease. And then there's another medication, magnesium, that I feel like we sometimes forget, can be used in conjunction with any of these other medications and can sometimes help emphasize and get that rate control that we need for our patients. Well, thank you for tuning in. I hope you guys enjoyed that. And stay tuned for part six, the role of an ED observation unit.

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