Annals of emergency medicine
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Multicenter Study
Variation in management of recent-onset atrial fibrillation and flutter among academic hospital emergency departments.
Although recent-onset atrial fibrillation and flutter are common arrhythmias managed in the emergency department (ED), there is insufficient evidence to help physicians choose between 2 competing treatment strategies, rate control and rhythm control. We seek to evaluate variation in ED management practices for recent-onset atrial fibrillation and flutter patients at multiple Canadian sites and to determine whether hospital site was an independent predictor of attempted cardioversion. ⋯ We demonstrated a high degree of variation in management approaches for recent-onset atrial fibrillation and flutter patients treated in academic hospital EDs. Individual hospital site, age, previous cardioversion, and associated heart failure were independent predictors for the use of rhythm control.
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Comparative Study
A rapid medical screening process improves emergency department patient flow during surge associated with novel H1N1 influenza virus.
We compare emergency department (ED) patient flow during the fall 2009 novel H1N1-associated surge in patient volumes at an urban, tertiary care, pediatric medical center to that in the previous winter virus season. ⋯ The implementation of a rapid screening process during the fall 2009 H1N1-associated surge in patient volumes was associated with improved patient flow without affecting rates of return to the ED within 48 hours or 7 days. This was accomplished with only a modest increase in staffing.
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Case Reports
Asymptomatic sustained ventricular fibrillation in a patient with left ventricular assist device.
Optimal medical treatment, cardiac resynchronization, and the use of an implantable cardioverter defibrillator are established therapies of severe congestive heart failure. In refractory cases, left ventricular assist devices are more and more used not only as bridging to cardiac transplantation but also as destination therapy. ⋯ Consecutive adequate but unsuccessful discharges of the implantable cardioverter defibrillator were the only sign of the usually fatal arrhythmia, prompting the patient to consult emergency services. Electrolyte supplementation and initiation of therapy with amiodarone followed by external defibrillation resulted in successful restoration of a stable cardiac rhythm after 3.5 hours.