Good morning, Priya 👋

62F, new-onset AF 48h post-lap chole. Rate control failed on β-blocker + digoxin. TSH 0.3. Considering DCCV — thoughts?

Patient is otherwise well. No prior AF documented. Rate 130–150s despite loading dose. CHA₂DS₂-VASc = 3. Team is split between TEE-guided DCCV vs 3-week anticoag + elective DCCV.

Post-cardiac-arrest cooling protocol — how are your units handling shivering at the 33°C target?

We've been using bolus fentanyl + intermittent cisatracurium but seeing breakthrough shivering on the BSAS around hour 6–8, which then bumps our targeted temp by 0.4–0.6°C. Interested to hear whether other units have moved to a scheduled dexmedetomidine backbone, and how you're documenting the tradeoff for the medical team's morning review. Would love a written protocol if anyone's happy to share.

Karolinska is retiring the 5th-gen troponin reflex protocol — here's what changed and why the ED and cardiology teams should know

From Oct 1 we're moving to a single-draw hs-cTnI pathway with a 1-hour rule-out/rule-in algorithm (ESC 2023 revision). Reflex serial draws only trigger when the initial value falls in the observational zone. This changes the timing of your admission decisions for chest pain — full protocol PDF and a decision tree attached below. Cardiology and EM feedback welcome before we go live.

Early rhythm control in atrial fibrillation with heart failure: 3-year outcomes from EAST-AFNET 5

The extension trial confirms the mortality benefit of early rhythm control seen at 24 months holds at 3 years, with a widening gap in the HFrEF subgroup. Practice-changing for us — we've already updated our AF-HF protocol.

Post-TAVR cardiac rehab — what percentage of your patients under 70 complete the full 12-week program? We're at 58% and want to compare.

Curious to hear from other centers — the drop-off pattern we see is week 3–4 (mostly return-to-work), then a second dip around week 8. If your center is doing telehealth-supported rehab, does that shift completion rates? Considering piloting a hybrid model for our under-70 TAVR cohort.

Reminder — flecainide + ondansetron in loading protocols: QT prolongation risk is being systematically under-recognised at our centre

Reviewed 240 admissions in the past 6 months where flecainide loading was ordered without a documented QT check when ondansetron had been given in theatre. 18% had QTc >480ms on next ECG. Not calling for a change to prescribing — just asking anaesthesia and cardiology teams to add the QT check to the loading order set. Happy to share the audit + a draft order-set template.

How is your department handling AI-flagged incidental findings on chest CT?

West African Emergency Medicine consensus on paediatric sepsis — public comment now open (14 days)

The WAEM working group has published draft guidelines for pre-hospital and ED management of paediatric sepsis in resource-limited settings. Divergences from Surviving Sepsis Campaign are highlighted in §4.