ED calling cardiologist

[Houstonian]

The cardiologist's response was not appropriate, in that he was somewhat derogatory and insipid.

 

This patient had already had one atrial fib ablation. The second atrial fib ablation would have been planned due to recurrent atrial fib occurring after the first ablation, to improve on the prior one.

 

The patient was already on rate control (beta-blocker) and anti coagulation (Xarelto), but nonetheless presented with rapid atrial fib with associated symptoms.

 

Increasing the beta-blocker dose (after initial stabilization with IV med) continues the same basic management approach (rate control and anti coagulation for recurrent afib, until a second ablation could be performed).

 

Perhaps, it would have been helpful if you had been highly specific regarding what sort of advice you wanted from the cardiologist, I.e.

 

1) would you recommend that we initiate Amiodarone or another anti-arrhythmic?

 

2) shall we transfer the patient to another hospital?

 

Management might also be affected by whether there are any cardiologists onsite available for hospital consultation.

 

There are many options available for treatment of atrial fibrillation, but deciding on an approach usually requires thoroughly assessing the patient, not always something that can be easily handled by a brief phone call.

[Boatswain2PA]

Paula - I just saw your question about pinworms......no, I didn't check her for pinworms.  I didn't know that pinworms could cause vaginitis, which is now a fact that I find kinda disturbing.  Just another reason I don't like family practice. 

Houstonian - I have recently heard/read other suggestions about how ED calls to specialists should be very specific and question oriented and I realized I am NOT always doing that.  Most of my phone calls are to EPs just asking them to accept which usually is a very brief conversation ("80 mph rollover with ejection, grey matter, intubated, would like to send your way asap via air" gets an "ok"). 

Most of the time when I'm calling ortho I will kind of follow the same thing.  "Anterior shoulder dislocation, reduced, neurovascular intact, would like him to see you in clinic in 2-3 days" gets me an "ok thanks". 

But these are cut & dry situations, the pt HAS to go to be transferred, or I've already fixed the acute problem and I'm just making sure there's follow up. 

I often DON'T do this for cardiology consults, and my feeling is I DON'T do this because there are soooooo many different ways to manage many of the cardiology issues.  It's one thing to call about a STEMI, but the electrical problems seem to be more myriad, and therefore have more management options, which often seem (to me) to be very provider specific versus patient specific.  So I am often calling the cards asking what THEY want me to do for their patient.

Any other EM guys feel the same way?  Or am I an outlier and need to reconfigure something??

 

[EMEDPA]

I generally don't call a cardiologist unless I want them to take the pt in transfer. Too many of them can be unpleasant if you just call to ask their opinion on something you already know several possible answers for.

[Boatswain2PA]

Okay, thanks E.