Atrial Fibrillation In The ED

Cardioversion, Rate Control, Anticoagulation, And More

Pollock, Gary F. MD, FACEP
Herbert, Mel E. MD, MBBS, BMedSCi, FACEP
Slovis, Corey M. MD, FACP, FACEP

Author Gary F. Pollock, MD, FACEP Clinical Instructor of Emergency Medicine, University of Pittsburgh Affiliated Residency in Emergency Medicine; Assistant Education Director, Trauma Liaison, The Mercy Hospital of Pittsburgh, Pittsburgh, PA.
Peer Reviewers
Mel E. Herbert, MD, MBBS, BMedSCi, FACEP Assistant Professor, Medicine, UCLA School of Medicine; Assistant Professor, Nursing, UCLA School of Nursing, Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, CA.
Corey M. Slovis, MD, FACP, FACEP Professor of Emergency Medicine and Chairman, Department of Emergency Medicine, Vanderbilt University Medical Center; Medical Director, Metro Nashville EMS, Nashville, TN.

Emergency Medicine Practice 4(8):p 1-26, August 2002.

The man in bed 2 is pale and diaphoretic. The monitor shows a heart rate of 160 and a blood pressure of 70. The nurse looks at you and says, “Doctor, what should we do?” The elderly lady in the next bed is yelling, “Doctor, my chest hurts!” Her monitor tells all—an irregular wide complex rhythm at a rate of 130. You ponder what drug to give. Just then, the medics break through the door with yet another patient with a fast heart rate. The adenosine they administered didn't help.

As the confusion and pressure mount, you hear a faint shriek of an alarm—first, distant; then, more insistent. You wake. Thank goodness, it was only a dream. As you walk into the ED for your morning shift, the charge nurse grabs your arm and says, “The guy in bed 2 really needs you…his heart rate is 160.”