REBEL Core Cast 21.0 - ECG in Syncope
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Take Home Points
Background Information: Atrial fibrillation is the most commonly encountered dysrhythmia in the emergency department (ED) and is associated with an increased long-term risk of stroke, heart-failure and all-cause mortality.1,2 In fact, the overall mortality rate for patients with atrial fibrillation is approximately double that of patients in normal sinus.3,4 The decision to rate vs. rhythm control patients while in the emergency department remains controversial in the literature and the method of doing so using chemical vs. electrical cardioversion also stirs up debate. Prior studies have shown the success rate of electrical cardioversion alone to be 90%.1,5 other studies have demonstrated that emergency physicians use each strategy roughly half the time.1 The authors of this study sought to determine if one of the two strategies resulted in achievement of normal sinus rhythm and discharge more quickly....Read More
Background: In patients with hemodynamically stable supraventricular tachycardia (SVT), vagal maneuvers are the traditional first step in management. There are several vagal techniques in the literature which include, standard valsalva maneuver (sVM), modified Valsalva maneuver (mVM), and carotid sinus massage (CSM). All three techniques aim to increase vagal tone to slow down conduction in the AV node and, hopefully, result in termination of Atrioventricular nodal reentry tachycardia (AVNRT)and atrioventricular reentrant tachycardia (AVRT). The authors of this trial performed a RCT evaluating the effectiveness of sVM vs mVM vs CSM at not only terminating SVT but also having a sustained effect up to 5 minutes....Read More
Background: Chest pain is a common chief complaint the Emergency Department, and the differential diagnosis includes life-threatening conditions from several organ systems including cardiac, pulmonary, and gastrointestinal, in addition to more benign etiologies. Historically, despite most patients not having acute coronary syndrome, there is still a high rate of medical admissions in patients with chest pain. The advent of accelerated diagnostic protocols has aided in guiding clinicians with decision making and disposition of these patients. This study aimed to address the question of whether or not an emergency medicine physician’s clinical gestalt would be sufficient to rule in or rule out acute coronary syndrome (ACS). Several studies have addressed this question with conflicting results.
Given the high morbidity and mortality of acute coronary syndrome, emergency medicine physicians focus their clinical decision making on decreasing type II errors, i.e., false negatives. In clinical practice, this means having a low rule-out rate based on physician gestalt; in other words, most patients with chest pain presenting to the Emergency Department will have testing including an EKG and troponin level even for patients for whom the physicians have a low clinical suspicion for ACS....Read More
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