Quote from austin heart
I only work weekends and we do a good deal of them in the ER if the EP docs are on call. I have at times done 3-4 in one day. We do them most times without giving drugs first. As I said, shock em' and send them home. Sometimes if the rate is high we will give the Cardizem to get the rate down before the cardioversion but not always if the EP guy is in house. I have never seen Dig given before hand. Most often they want them off the Dig with a planned cardioversion.
We have a protocol for pretty much everything except A-fib, LOL.
Thats unusual (and dangerous) the way you're describing a-fib cardioversions in ER. The biggest reason for that not being good medicine is because in elective cardioversion for a-fib the pt is at big risk for embolism and should be adequately anti-coagulated first. An echo is obtained before-hand to r/o thrombus, etc. Also, as a few have stated, meds are vital to keep the AF from recurring (which, unfortunately, occurs alot w/af cardioversions).
If someone walks into the ER with A-fib (especially new a-fib), a work-up is in order and the patient gets (should get!)admitted, buys a cardiologist, etc. And if someone walks into the ER with chronic a-fib and gets shocked, they're VERY likely to relapse...especially if (as you say) they're taken off dig., no drugs, etc.
Meds are always the first choice (rate control, etc.)...and then if pt remains symptomatic a cardioversion may then be in order...under controlled conditions...
You may not have seen it (yet), but when one of these "3-4 af cardioversions a day in the ER" throws a clot, dies of ventricular standstill (from cardioversion), or otherwise does poorly, i'm betting your er will change its ways. Until then, your er is acting dangerously and is potentially setting itself up for bad things.
Lastly, if the rate is way up and patient is unstable, of course your hands may be tied and emergent cardioversion would be neccessary. However, an unstable a-fib refractory to meds is the exception (big exception) rather than the norm. It's too bad that its not as easy as 'shock em and send them home'...
(my entire post may be wrong if you were meaning your hospital schedules elective cardioversions for a-fib...which are then done in er (weird??- slow er??) rather than in an ep-lab, CCU, CardiacIMCU, etc. These folks would then surely have had work-ups, been anticoagulated, etc.)