Cardioversion tomorrow January 15, 2020 01:24PM |
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Re: Cardioversion tomorrow January 15, 2020 01:37PM |
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Re: Cardioversion tomorrow January 15, 2020 02:26PM |
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Re: Cardioversion tomorrow January 15, 2020 02:48PM |
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I recently had a procedure that required anesthesia and a TEE. During the pre-admission appointment they told me nothing by mouth after midnight but later a nurse in the EP lab said that they had changed this recommendation to allow you to drink a small amount of clear liquid up to four hours before admission. This would pretty much match Carey’s experience of five hours before the procedure. I doubt if orange juice would be on their list of acceptable things to drink though. I was allowed black coffee which was the main thing I wanted to drink as I have low blood pressure.Quote
Carey
George is right that it's a safety concern with the anesthesia and with putting a probe down your throat. If you were to vomit while under anesthesia, you wouldn't have a gag reflex and so could inhale food and stomach acid, which is a really bad thing.
Telling patients nothing after midnight is just stock instructions they give everyone. Makes it easier in case the procedure gets rescheduled earlier. I've had a lot of cardioversions and TEEs, and pretty much every ER and anesthesiologist I've ever run into sets the cutoff at 5 hours. I guess U of M is using 8 hours, which is pretty conservative. Personally, I wouldn't have a problem waiting but if I felt I just had to have something I'd probably have some juice before 6:00 am.
Re: Cardioversion tomorrow January 15, 2020 11:56PM |
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Re: Cardioversion tomorrow January 16, 2020 06:08PM |
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Re: Cardioversion tomorrow January 16, 2020 06:33PM |
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Re: Cardioversion tomorrow January 16, 2020 06:59PM |
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Re: Cardioversion tomorrow January 16, 2020 07:39PM |
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Re: Cardioversion tomorrow January 17, 2020 03:40AM |
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Re: Cardioversion tomorrow January 17, 2020 11:51AM |
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Re: Cardioversion tomorrow January 17, 2020 01:40PM |
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Re: Cardioversion tomorrow January 17, 2020 04:27PM |
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Re: Cardioversion tomorrow January 17, 2020 04:43PM |
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Re: Cardioversion tomorrow January 17, 2020 07:14PM |
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I wonder if they could convert an Afib patient (who also had an implanted defibrillator) by activating it?Quote
Carey
How many joules does an implanted defibrillator deliver?
Much lower, down in the 10-40J range. Since it's attached directly to the heart you don't need a bunch of energy to get through the impedance of the skin, chest wall, etc.
Re: Cardioversion tomorrow January 17, 2020 09:13PM |
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Quote
Daisy
I wonder if they could convert an Afib patient (who also had an implanted defibrillator) by activating it?
Re: Cardioversion tomorrow January 18, 2020 12:01AM |
Registered: 4 years ago Posts: 725 |
And that is an even more interesting idea. I was actually just wondering what if an Afib patient had an ICD for the usual reasons and they went into a few days of Afib, that maybe their EP/Cardiolgist could convert them by activating their ICD in their office. There must be a way to do it by getting into the settings—and though it wouldn’t be pleasant it would be better than persistent Afib.Quote
Carey
I wonder if they could convert an Afib patient (who also had an implanted defibrillator) by activating it?
If it were programmed to do so I don't see why not, but they'd have to be super-careful with the programming. For example, an ICD shock is a decidedly unpleasant event, so they'd have to set a limit on how many shocks it would deliver. It's one thing to try endlessly to terminate a lethal rhythm because the alternative is death, but it's quite another to keep shocking someone who's gone into persistent afib. And what about shocking someone while they're driving down the interstate, climbing a ladder, or doing eye surgery? I think it would need to include a warning a shock was coming and offer a way to cancel it.
Interesting idea but I've got a feeling we won't be seeing ICDs for afib anytime soon because the view would be it's a very expensive band-aid with significant complications for a non-lethal disease and significant risks for the manufacturers. I can hear Mandrola howling about it now. ;-)
Re: Cardioversion tomorrow January 18, 2020 12:14AM |
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Re: Cardioversion tomorrow January 18, 2020 07:05AM |
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Quote
Daisy
I wonder if they could convert an Afib patient (who also had an implanted defibrillator) by activating it
.
Re: Cardioversion tomorrow January 20, 2020 10:08AM |
Registered: 5 years ago Posts: 269 |
Quote
Carey
There are several videos of cardioversions on youtube if you want to know how it really looks.
This one is my favorite. It's amusing and it demonstrates why you should never allow yourself to be talked into a cardioversion under conscious sedation. Demand full sedation.
Re: Cardioversion tomorrow January 20, 2020 01:29PM |
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Re: Cardioversion tomorrow January 20, 2020 02:54PM |
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Re: Cardioversion tomorrow January 20, 2020 03:02PM |
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Re: Cardioversion tomorrow January 20, 2020 08:45PM |
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Quote
Elizabeth
Susan:
You are only in AF for 1 hour when you go to ER? They don't cardiovert you after only 1 hr. in AF do they? Most of us wait our AF episodes out.
Sorry about your foot.
Liz
Re: Cardioversion tomorrow January 20, 2020 09:30PM |
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Quote
susan.d
My question is why do you wait it out? You must not be symptomatic otherwise why wouldn’t you want to go to the ER for 2 g of magnesium and drugs to get rid of the AF if it works and if all else fails get cardio converted?
Re: Cardioversion tomorrow January 20, 2020 10:46PM |
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Quote
Carey
But just waiting it out at home was better than waiting it out in an ER at $3000 per visit.
Re: Cardioversion tomorrow January 20, 2020 11:08PM |
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Re: Cardioversion tomorrow January 21, 2020 01:18AM |
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Quote
GeorgeN
I'm all about minimizing time out of rhythm, but the ER trip is my last, not first resort.
Re: Cardioversion tomorrow January 21, 2020 05:08AM |
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Quote
Carey
I'm all about minimizing time out of rhythm, but the ER trip is my last, not first resort.
Exactly. For most people the ER isn't where you want to be during an afib episode.
It's very unlikely they'll do anything useful for you and sure as heck unlikely they'll cardiovert you unless you have a super-high heart rate or are in distress.
Re: Cardioversion tomorrow January 21, 2020 10:14AM |
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Quote
Carey
I'm all about minimizing time out of rhythm, but the ER trip is my last, not first resort.
Exactly. For most people the ER isn't where you want to be during an afib episode.
It's very unlikely they'll do anything useful for you and sure as heck unlikely they'll cardiovert you unless you have a super-high heart rate or are in distress.
Re: Cardioversion tomorrow January 21, 2020 10:57AM |
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Quote
susan.d
. My pet peeve is an ER doctor who would say there is nothing wrong with living in AF. Let him try out my AF and get back to me “how does he like it?”
Re: Cardioversion tomorrow January 21, 2020 01:37PM |
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Re: Cardioversion tomorrow January 22, 2020 10:21AM |
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Quote
susan.d
Liz, ER’s cardio converts all the time. I trust them. The only time my cardiovert wasn’t in the ER was during my ablation under the gifted hands of the master Natale.
Regarding routine description: Maybe because they know me at the ER by sight or it’s in their computer details, I am greeted by security and I pass through an TSA type X-ray arch and my purse is checked, I’m asked why I am there and I say AF and they get a wheelchair which is stacked in a corner and wheel me to one part of the ER (the other side is non urgent cuts, broken bones etc). Once I enter the higher tier ER I am greeted by passing staff or doctors on the way to triage asking me if it’s AF again before I reach triage where my name is entered, computer screen up and vitals and ekg is given. Then I am wheeled to a room and greeted by my assigned nurse who recognizes me and I ask who is on duty that night (it’s always in the night) and that I have AF and request a cardiovert. I then ask which nurses are on duty because some are vein whisperers and can insert an IV without popping my veins. This may be my only ER concern due to chemo destroyed/burned most of my good veins. I pick a good vein and get jabbed. I am asked if I am still on Eliquis and if I have returned abroad the past 10 days? Only once it was less than 10 days from flying and for precaution because of my history of DVT, I was required to get a TEE. That was the only time I wasn’t in and out.
I just flew home Saturday night and stopped Multaq so the next week window I hope I am AF free because it took 5 hours to get a TEE and be converted that one time after flying. The other times the assigned doctor arrives and I request a cardiovert with "a push of 50 of propofol and 50 joules” because that dose works for me. While they setup, admission arrives for a signature (my insurance is on file), and an X-ray is taken, I get converted and a RN sits with me for an hour and I go home.
I am fortunate to had found this particular hospital. It’s not the closest to my home, there are many closer but with the others I would get the negative dragged out experience Carey commented he described. I take a Lyft to a further ER that is cardiovert friendly. Because it’s not the closest, I once naturally converted once in the car and the driver turned around.
Re: Cardioversion tomorrow January 22, 2020 12:10PM |
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