2019, Defibrillator and ED - Paramedicine Now

Guidelines would (erroneously) say that this patient who was defibrillated and resuscitated does not need emergent angiography

Dr. Smith's ECG Blog

JUNE 27, 2024

A patient had a cardiac arrest with ventricular fibrillation and was successfully defibrillated. Here was his initial ED ECG: Formal interpretation by interventional cardiologist: There is "Non-diagnostic" ST Elevation in V2-V4 and aVL. Lemkes JS, Janssens GN, van der Hoeven NW, et al.

Defibrillator

Defibrillator STEMI Coronary ALS

SGEM#344: We Will…We Will Cath You – But should We After An OHCA Without ST Elevations?

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

He is interested and experienced in healthcare informatics, previously worked with ED-directed EMR design, and is involved in the New York City Health and Hospitals Healthcare Administration Scholars Program (HASP). She arrives in the emergency department (ED) with decreased level of consciousness and shock.

EMR

EMR Coronary Defibrillator Life Support

What the Emergency Clinician Must Know about Remote Monitors in Heart Failure

EMDocs

JANUARY 3, 2024

He has been taking increased doses of torsemide without improvement in his symptoms and was directed to the ED for inpatient therapy. Now, a remote outpatient pulmonary arterial pressure monitor and other heart failure detection devices (Table 1) are available that you may begin to see in your ED.

Defibrillator

Defibrillator Allergic Reaction ED ALS

Hypothermic Cardiac Arrest: Pearls and Pitfalls

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). His blood sugar was normal en route to the ED, and his initial rhythm on the cardiac monitor was asystole. It is unclear how long he was down.

Defibrillator

Defibrillator CPR Epinephrine Life Support

A man in his 50s with acute chest pain who is lucky to still be alive.

Dr. Smith's ECG Blog

JUNE 21, 2023

In this medical system, the EMS provider can then be routed to the ED or to a type of urgent care facility that is open 24 hrs/day and staffed by a primary care provider. Clinical Cardiology 2019. In this case, the EMS provider was routed to the urgent care facility. The LCX was noted to be "subtotally stenosed" at the time of cath.

STEMI

STEMI Coronary Defibrillator EMS

What Lies Beneath

EMS 12-Lead

AUGUST 22, 2022

We can, therefore, put down the defibrillation pads, set aside the amiodarone, and look further at the ECG. Chou’s Electrocardiography in Clinical Practice (6th ed). Paradoxically, though, the third green arrow identifies a QRS that is more narrow than the RBBB complexes surrounding it. Pacing Clin Electrophysiol., 40, 1234-41.

E-9-1-1

E-9-1-1 Coronary ALS ICU

Noisy, low amplitude ECG in a patient with chest pain

Dr. Smith's ECG Blog

JANUARY 15, 2024

Rhythm B: This patient was seen in the ED — and thought to be in AFlutter with 4:1 AV conduction. Rhythm C: This telemetry strip from an older adult was initially thought to need defibrillation. The September 27, 2019 post — for the Rowlands & Moore article with the above-noted formulas for recognizing the “culprit” extremity.

Critical Care

Critical Care Defibrillator OR ALS

What Is the Best Defibrillation Strategy for Refractory Ventricular Fibrillation?

ACEP Now

NOVEMBER 7, 2023

A 67-year-old man presents to the emergency department (ED) in cardiac arrest. Multiple attempts at defibrillation, epinephrine, and amiodarone have been unsuccessful. On ED presentation, he is unresponsive and the monitor shows ventricular fibrillation. He was found by bystanders after he collapsed and 911 was called.

Defibrillator

Defibrillator E-9-1-1 ALS Epinephrine

What is strange about this paroxysmal atrial fibrillation in an otherwise healthy patient? And what happened after giving ibutilide?

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. Methods. . =

ALS

ALS OR Defibrillator ED

A Middle-Aged male with Chest Pain and an Unusual ECG

Dr. Smith's ECG Blog

MAY 6, 2019

Only 5-18% of ED patients with chest pain have a myocardial infarction of any kind. Cardioversion/defibrillation. Could this be a coincidence that the patient was experiencing chest pain and upon ECG capture the atypical brugada pattern was found? Answer : History is insensitive and nonspecific. It helps a little bit. Hypothermia.

STEMI

STEMI Defibrillator OR ALS

Cardiac Rhythms/ECG Module

Don't Forget the Bubbles

JULY 26, 2023

Prioritise listening to the first 30 minutes which given a good overview of aetiology and treatment (53 mins) Basics of cardiac rhythm problems in the ED Palpitations are a common reason for children to present to the emergency department, the majority of these will be benign from a cardiac perspective and instead related to stress or anxiety.

ALS

ALS ED OR CPR

A young F is hyperthermic, delirious, and dry: Fever-induced Brugada? Diphenhydramine toxicity? Tricyclic?

Dr. Smith's ECG Blog

DECEMBER 5, 2019

--If she has fever, she should aggressively take acetaminophen and/or ibuprofen and, if not improving, will need to go to ED for further evaluation. --If If there are any syncopal or presyncopal events, she should be evaluated immediately in the ED. --All Annals of Noninvasive Electrocardiology 2019. 8, 2019 ) — ( Jan.

ALS

ALS OR Defibrillator STEMI

Interventionalist at the Receiving Hospital: "No STEMI, no cath. I do not accept the transfer."

Dr. Smith's ECG Blog

SEPTEMBER 21, 2020

He was found in ventricular fibrillation and defibrillated, then brought to a local ED which does not have a cath lab. Here is the initial ED ECG: This is pretty obviously and inferior posterior OMI, right? The patient was defibrillated, and then taken to the nearest ED where ECG #1 was obtained ( Figure-1 ).

STEMI

STEMI Defibrillator ED ACS

Two 70 year olds with chest pain, and 3 pitfalls of the STEMI paradigm

Dr. Smith's ECG Blog

FEBRUARY 13, 2023

If the patient only had these two ECGs recorded, it would have missed the transient time between them which were STEMI positive, and the patient would then have arrived at the ED as “serial ECGs STEMI negative." Eur Heart J 2019 = Comment by K EN G RAUER, MD ( 2/13 /2023 ): = I love cases like this one! Eur Heart J 2018 4.

STEMI

STEMI Paramedic Coronary ALS

Hypothermia at 18 Celsius in V Fib arrest: CPR, then ECMO rewarming, for 3 hours, then Defib with ROSC. Interpret the ECG.

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

The patient was put on Extracorporeal Life Support in the ED 3 hours after initial resuscitation, the core temp was 30° C and the patient was defibrillated with a single attempt. This Transesophageal ED Echo was recorded: Cardiac POCUS.mov from Stephen Smith on Vimeo. In all leads, there is a 2nd wave after the initial QRS.

CPR

CPR Defibrillator Life Support ED

Chest pain, among other symptoms. What do you see?

Dr. Smith's ECG Blog

FEBRUARY 17, 2023

Features of Short QT Syndrome: From My Comment at the bottom of the page in the September 2, 2019 post of Dr. Smith’s ECG Blog: SQTS is an inherited cardiac channelopathy determined by the presence of symptoms ( syncope, cardiac arrest ) — positive family history — and the ECG finding of an abnormally short QTc interval.

STEMI

STEMI Defibrillator OR ED

Acute Chest pain in a 50-something, and a "Normal" ECG

Dr. Smith's ECG Blog

AUGUST 17, 2019

Defibrillated out of v fib in the cath lab. For clarity — I’ve labeled a number of KEY findings in the initial ECG performed in the ED ( = E CG # 1 in Figure-1 ). Figure-1: The initial ECG done in the ED ( See text ). "Cardiology agreed to take the pt to the lab but thought it would likely be negative.

STEMI

STEMI Defibrillator ED OR

Hyperthermia and ST Elevation

Dr. Smith's ECG Blog

JANUARY 30, 2019

Heart Rhythm, 15(10), e73-e189. -- Comment by K EN G RAUER, MD ( 1/30/2019 ): -- Superb presentation and discussion by Dr. Alexandra Schick ( with edits by Dr. Smith ) of an elderly woman who was seen in the ED for altered mental status, hyperthermia, and the initial ECG shown above. Heart Rhythm, 15(9): 1394-1401. [7]

E-9-1-1

E-9-1-1 CAD STEMI OR

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

She was defibrillated and resuscitated. To Emphasize: The reason definitive diagnosis is important in today's case — is that the senior ED physician interpreted ECG #1 as "nothing too exciting". Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Emergency Department

Emergency Department E-9-1-1 Coronary STEMI

Paramedicine Now

Guidelines would (erroneously) say that this patient who was defibrillated and resuscitated does not need emergent angiography

SGEM#344: We Will…We Will Cath You – But should We After An OHCA Without ST Elevations?

Trending Sources

What the Emergency Clinician Must Know about Remote Monitors in Heart Failure

Hypothermic Cardiac Arrest: Pearls and Pitfalls

A man in his 50s with acute chest pain who is lucky to still be alive.

What Lies Beneath

Noisy, low amplitude ECG in a patient with chest pain

What Is the Best Defibrillation Strategy for Refractory Ventricular Fibrillation?

What is strange about this paroxysmal atrial fibrillation in an otherwise healthy patient? And what happened after giving ibutilide?

A Middle-Aged male with Chest Pain and an Unusual ECG

Cardiac Rhythms/ECG Module

A young F is hyperthermic, delirious, and dry: Fever-induced Brugada? Diphenhydramine toxicity? Tricyclic?

Interventionalist at the Receiving Hospital: "No STEMI, no cath. I do not accept the transfer."

Two 70 year olds with chest pain, and 3 pitfalls of the STEMI paradigm

Hypothermia at 18 Celsius in V Fib arrest: CPR, then ECMO rewarming, for 3 hours, then Defib with ROSC. Interpret the ECG.

Chest pain, among other symptoms. What do you see?

Acute Chest pain in a 50-something, and a "Normal" ECG

Hyperthermia and ST Elevation

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

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