itchiness after cardioversion

What do you all do to help the itch from the burns after cardioversion? Silver Sulfadiazine cream has helped before but is not presently. Anyone have ideas?

My opinion - too many joules. I've had two 300 joules ECVs and they left redness and itching. I also had a 200 that did not leave any problems (and worked 1st time) and a 250 joules that left some. 225 is likely the sweet spot for me.

Aloe vera might help.

Too many joules and/or sensitive skin and/or incorrectly applied pads. If the pads aren't applied firmly such that there are no air gaps, air gaps can create sparks, which can burn the skin.

I guess I've got tough skin or I'm just lucky. I've been cardioverted 15-20 times, almost always with 100, which always worked with one shot, but a few times with 200J and once with 360J. None of those left any marks whatsoever. Oddly, the 200 and 360 were done by EPs; all the 100s were done by ER docs.

I've been cardioverted several times without any such issues

How about Hydrocortisone cream?

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I recommend the 4% linocaine burn gel and the calamine plus. Cvs has it and Instacart delivered it to me within 45 minutes. I always get burns or irritation lately especially if the joules are >50. However lately I speculate it’s the adhesive I am allergic to because Los Robles Hospital pads are different than the local ER I used to go to and I never got irritated over 24 ECV’s the other times elsewhere.

Thanks all. Interesting I recall them talking about joules. I wonder if I can find that info. I have been cardioverted 5-10 times I think.. So why more or less joules? They also had to do it 3 times. They also gave me fentanyl along w/ etamadate (sp??) .. I had never gotten the fentanyl. it was at an ER.

Ah, the three tries probably explains it. The usual protocol would be to start with 100J then go to 200J and then 360J if it didn't work. So you took three shocks to the same two small patches of skin with the last one being the highest power they use. Probably no surprise you've got some irritation.

The fentanyl and etomidate are a bit unusual but protocols on what to use vary a lot in ERs across the US. Propofol is the most common choice but some hospitals require the ER doc to get an anesthesiologist involved to use propofol, so it's just quicker and easier for the ER to use other drugs.

I've had 200j (1x), then 300j (3x) attempts the same day, while the "local" EP was doing a RAFlutter ablation.
NSR didn't last long after each attempt. I stayed in afib till the next day around 6 AM. I had burns on my skin and painful ribs (left side).

While we're at it anyone seen the cost related to an ECV?

I think it's about $4700 here in Texas.

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NotLyingAboutMyAfib
While we're at it anyone seen the cost related to an ECV?

I think it's about $4700 here in Texas.

That's the fantasy price hospitals bill everything at. It's like how they bill $200K for an ablation but accept payment of less than $40K. No insurance company would pay anywhere near that for a cardioversion. As a general rule of thumb they'll pay about 20 to 30 cents on the dollar. As I recall, I was billed similar amounts but the hospital accepted payments of around $500-$600.

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Carey
Ah, the three tries probably explains it. The usual protocol would be to start with 100J then go to 200J and then 360J if it didn't work. So you took three shocks to the same two small patches of skin with the last one being the highest power they use. Probably no surprise you've got some irritation.

The fentanyl and etomidate are a bit unusual but protocols on what to use vary a lot in ERs across the US. Propofol is the most common choice but some hospitals require the ER doc to get an anesthesiologist involved to use propofol, so it's just quicker and easier for the ER to use other drugs.

During my itching induced insomnia last night I was actually thinking that.. that maybe they went up and up. I have a GP appt at 1145 virtually to see if there is a magic cream I don't know about lol. I tried a Benadryl..t hen took a half a tiny Xanax to sleep. kind of. I am whining now but I miss my morning decaf. I figured I wouldn't spit. into the wind even with decaf right now. having tea.. blah. LOL.

I have had the propofol other places but this place has always done the etomidate. I have had anesthesia issues (although never with these two.). There was actually anesthesia there in the room. Along with 50 more of my closest friends. While they administered it they said, "where do you want to go on vacation?" I was like-- we can't go on vacation anywhere now.. hahaha.

Propofol IS the vacation.

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NotLyingAboutMyAfib
Propofol IS the vacation.

HAHAHA. yea I wish I had had that line...

If they offered propofol in a 'wake me up when 2020' is over version, I'd take it.

I always burned. Not a big deal for me. Just grinned and lived with it a few days. Minor issue for NSR.