The World’s Okayest Medic Podcast FRIDAY Coffee Talk (12/5/25)
Dec 5, 2025
Mike dives into the intricacies of managing atrial fibrillation, emphasizing fluid support over traditional rate control in certain patients. He shares engaging case studies, including one involving a septic patient and a debate on wide complex tachycardia. The conversation expands to the implications of amiodarone in patients with Wolff-Parkinson-White syndrome and the role of rapid AF in triggering dangerous ventricular arrhythmias. Alongside these medical discussions, Mike humorously critiques AI's influence in content creation and highlights the importance of mental health.
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Prioritize Cause Over Immediate Rate Control
- Treat AFib RVR by finding and addressing underlying causes before reflexively giving rate control drugs.
- Give fluids and identify sepsis or dehydration first, because slowing rate can remove necessary compensation and cause hypotension.
Cardizem Knocked Out Compensation
- Mike gave 0.25 mg/kg diltiazem to an elderly septic-appearing patient and the heart rate slowed while blood pressure crashed into the 60s.
- The patient required additional fluids and the on-scene choice illustrated the risk of knocking out compensatory tachycardia.
Don't Rate-Control The Hypotensive Patient
- Avoid giving diltiazem when the patient is hypotensive; prioritize fluids and conservative management instead.
- When arrival docs agree, continue fluids and defer cardioversion if the patient remains well-appearing despite AFib RVR.