AFib Cardioversion

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Swami calls back to an EM:RAP January 2023 segment on Atrial Fibrillation and the groups of patients you can safely cardiovert. 

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Brian S. -

Quick question?

Why is Etomidate superior to Ketamine in this setting?

Is it because of the possible sympathomimetic increase of the Ketamine, or is Etomidate just the preference of Dr. Swami in this instance?

Thank you.

Anand S. -

I prefer etomidate because it has:
1) Reliable onset w/o titration: single dose of 0.1 mg/kg will get almost all patients to proper sedation level in 60-90 seconds (no titration needed)
2) Short acting: patient will be awake and at baseline in 5-6 minutes

Ketamine may be bad because it increases endogenous catecholamines but, more importantly, it's going to act longer than etomidate with a more inconsistent onset profile

Brian S. -

Makes sense, thank you Dr Swami.

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