Dr. Casey Patrick is the EMS medical director of Montgomery County Hospital District (Texas). As an EM physician, he shares how he decides to care for his own patients in the ED who present with rapid atrial fibrillation. He wants paramedics to ask the same question he asks: Is the rapid A-fib the primary problem or secondary to another critical condition like sepsis, PE, DKA, hypovolemia, etc?
We get an exclusive, behind-the-curtain view of how he makes system-level decisions. Spoiler alert: He thinks a lot about his own decision making via literature review, metacognition, humility, contemplation during exercise, & checking in with trusted mentors.
Topics include:
how to discern if a dysrhythmic patient is hemodynamically stable or unstable
the differential diagnosis of a patient in rapid atrial fibrillation
which assessment tools to use in patients with rapid atrial fibrillation
his early resuscitation bundle-of-care recommendations for patients in rapid atrial fibrillation
the use of calcium-channel blockers, beta-blockers, Adenosine and Amiodarone
a literature review of academic journal papers on Diltiazem and EMS
There should be a 2-hour limit before you can give Diltiazem, or rate control, in the Emergency Department. I want to limit myself. […] We need time to sort out these patients & decide: Is the rate the primary problem or is the rate a result of a secondary illness.“
– Dr. Casey Patrick
Thank you, iSimulate.
This episode, and all episodes in The Thinking Series, are reviewed before publication by Maia Dorsett, MD, PhD.
Medic Mindset 