The Skeptics' Guide to EM

DECEMBER 7, 2018

A cardiac defibrillator is hooked up and the patient is in ventricular fibrillation. JAMA 2012 and Cournoyer et al. Case: A 51-year-old man experiences a cardiac arrest on the street. You are the first provider on scene with Emergency Medical Services (EMS) and start high-quality Cardiopulmonary Resuscitation (CPR).

Epinephrine 130

Epinephrine Life Support Advanced Life Support Defibrillator 130

EMDocs

SEPTEMBER 23, 2023

On arrival, vital signs are stable with a HR of 71, BP of 121/71 mmHg, RR of 17 bpm, and SpO2 of 97% on room air. Physical exam reveals a well-appearing female in no acute distress. Cardiac exam is unremarkable with normal S1/S2 without rubs, gallops or murmurs. Neurological exam is also unremarkable. Her presenting EKG is shown below.

E-9-1-1 84

E-9-1-1 EMS ALS Defibrillator 84

Dr. Smith's ECG Blog

MARCH 15, 2023

We examined the effect of ibutilide, a class III antiarrhythmic agent, on the energy requirement for atrial defibrillation and assessed the value of this agent in facilitating cardioversion in patients with atrial fibrillation that is resistant to conventional transthoracic cardioversion. She was on no medications. Potassium was normal.

ALS 52

ALS OR Defibrillator ED 52

Dr. Smith's ECG Blog

MAY 6, 2019

Cardioversion/defibrillation. It helps a little bit. Only 5-18% of ED patients with chest pain have a myocardial infarction of any kind. Only 1-5% have OMI. Anyone with a baseline Brugada pattern ECG can have esophageal pain, or chest wall pain, and then be thought to be having an MI based upon a false positive ECG. How can this be 'Not MI'

STEMI 52

STEMI Defibrillator OR ALS 52

ECG Medical Training

DECEMBER 4, 2016

Let’s also not forget that these patients still require ventilation and they still require defibrillation! We use the LUCAS device, and there are other devices out there like the AutoPulse or the Thumper. I understand that others may have different opinions about mechanical CPR, and that’s fine with me. ” Two points here.

CPR 52

CPR E-9-1-1 Defibrillator Ambulance 52

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

This episode self terminated before defibrillation was possible. mEq/L for Mg++ ) — given that ECF levels of these cations comprise only ~1-2% of total body stores ( Jahnen-Dechent and Ketteler — Clin Kidney J 5(Suppl 1):i3-i14, 2012 — and — Udensi and Tchounwou — Int J Clin Exp Physiol 4(3): 111-122, 2017 ). mEq/L for K+ and 1.76

E-9-1-1 98

E-9-1-1 ALS Defibrillator OR 98

NAEMSP

APRIL 19, 2023

CPR is taken over by responding crews, and he is placed on a cardiac monitor/defibrillator. After several cycles of defibrillation, epinephrine, and amiodarone, the patient remains in cardiac arrest. The study included 109 hyperkalemic cardiac arrest patients from 2006 through 2012. mEq/L (OR: 51.11; 95% CI: 3.12−1639.16;

E-9-1-1 52

E-9-1-1 Advanced Life Support Overdose CPR 52