Just had a patient take a pill in the pocket dose of flecainide for the first time. I do not do pill in the pocket. I know what it is and how to dose it. This patient had all the proper workup for flecainide. I did not have to worry about that.

I was reviewed their implanted rhythm monitor (loop recorder) and know they truly were in afib/flutter with high rates for a couple of hours. They were symptomatic. I decided to instruct them on the dose. I also ensured they had apixaban (Eliquis) on hand still as their episode was multiple hours at that point according to the loop recorder. There is guidance on whether or not the anticoagulation is truly necessary here, I chose to use AC.

The patient did convert after the dose of flecainide confirmed by checking the loop recorder the next morning.

It is possible that this patient would have converted on their own. However, since they were symptomatic I chose to do pill in the pocket. The symptoms were not strong enough to warrant ER contact, but enough that the patient could do this and possibly get relief. They received instructions on what to do over the weekend if they have another episode and are asymptomatic or symptomatic and what follow up was to be expected.

Overall, this was an excellent experience for me and the patient was cared for appropriately.

Thoughts, questions and discussion with any others here (regardless of role in healthcare) on this situation? Using Education" flair since there is not one for discussion.