Tasty Morsels of EM 097 – #FRCEM Atrial Fibrillation

31 Jul

I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.

You can find more things on the FRCEM on this site here

As summarised in the OHEM and NICE 2014 Guidelines

Name some non cardiac causes of AF?

  • sepsis
  • PE
  • hypovolaemia
  • thyrotoxicosis
  • electrocution
  • hypokalaemia
  • hyporthermia
  • cocaine
  • the ultra fit
  • alcohol or withdrawal

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How do you Assess Stroke Risk?

  • CHADSVASC
    • Age (<65 | 65-74 | >75)
    • Sex – female being higher risk
    • CHF
    • High BP
    • Stroke (+2)
    • Vascular disease
    • Diabetes
  • higher risk patients (>1) should be anticoagulated (NICE allows any of the DOACs or Warfarin)
  • they also note don’t bother with asprin monotherapy
  • note that people back in sinus with an ongoing future risk of AF should be treated the same

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How do you Assess Bleeding Risk?

  • HAS-BLED
    • Hypertension
    • renal disease
    • Liver disease
    • stroke
    • prior major bleeding
    • labile INR
    • AGE>65
    • Meds (aspirin, NSAID)
    • Alcohol (>8 drinks/wk)

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When do you use rate v rhythm control?

  • go for rate control in general except
    • AF has reversible cause
    • when any heart failure is due to the AF
    • new onset
    • flutter where ablation is considered appropriate
    • the ever wonderful “clinical judgement”
    • when still symptomatic despite rate control

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