Quote:
Originally Posted by Patriot007
Agreed. Often times in medicine definitions arise from the need for standardizing conditions for the purpose of research and are not that helpful to the ones who first reach patients at Death's door and do initial stabilization. This is one of the challenges of field and emergency medicine as when the dust settles there will always be someone standing there in a controlled environment with more stable vitals, a full set of labs, and a CT result with a diagnosis saying "duh stupid!".
Remember, rapid afib for some patients is their sinus tachycardia. If you are sick or stressed and have afib, your afib just beats faster, just like your heart does. There are times when this will get the patient in trouble but often times rate control is contraindicated if you are blunting the patient's normal physiologic response E.G. sepsis, dehydration, hemorrhagic shock.
I've seen and given rate control in several instances where it was hard to pick up on an underlying cause. It happens. It is one of the perils of treating an undifferentiated patient without the luxury of time. It is our job to try to minimize this risk by doing the best quick review of systems that we can (including bystanders) AND realizing when an intervention is not needed just as much when it is needed.
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Agree 100%. A good case for "less is sometimes more". As I said earlier, this is particularly true for cardiac cases IMO. Pharmacological intervention in these cases scare the crap out of me. No margin of error and when it goes badly it really goes badly very fast. Very unforgiving of error.
Thanks for the post. Learning here.
