Thursday, October 19, 2017

The Pulseless Extremity: An Approach to Acute Ischemic Limb

Image Source: Wikimedia
This post was peer reviewed.
Click to learn more.

Authors: Benjamin Mogni, MS-3
University of Kentucky
RSA Wellness Committee Member

Terren Trott, MD, Assistant Professor
University of Kentucky

A 55-year-old man with a past medical history of atrial fibrillation and aortic atherosclerosis presents to your emergency room with numbness, tingling, and pain in his left lower extremity below the knee. A tech is pushing him in a wheelchair because the pain is too great and he cannot move his foot. His foot appears pale in comparison to the other. The patient writhes uncomfortably in bed. Brief examination of the leg demonstrates a cold extremity with no posterior tibial or dorsalis pedis pulses.

Sunday, October 15, 2017

Management Strategies for Acute Atrial Fibrillation in the Emergency Department - Resident Journal Review

Authors: Eli Brown, MD; Allison Regan, MD; Kaycie Corburn, MD; Jacqueline Shibata, MD
Edited by: Jay Khadpe, MD, FAAEM; Michael C. Bond, MD, FAAEM
Originally Published: Common Sense September/October 2013

Introduction
Atrial fibrillation (AF) and atrial flutter (AFL) are the most commonly occurring arrhythmias in the United States. Management strategies for AF and AFL emphasize ventricular rate control, cardioversion to normal sinus rhythm and long-term interventions such as anticoagulation to reduce the risk of stroke. In patients in whom cardioversion is an option, either pharmacological or electrical cardioversion may be considered. While there is a significant amount of literature comparing the effectiveness and safety of pharmacologic versus electrical cardioversion in acute AF, studies which analyze discharge rates and hospital length of stays are becoming more frequent due to concerns over rising healthcare costs and ED overcrowding. This review focuses on treatment strategies for patients presenting to the ED with acute atrial fibrillation; in particular, rate control versus cardioversion, options for cardioversion (chemical versus electrical) and the safety of these strategies when used in the ED.