2020, 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. As per Dr. Smith — the intuitive answer should be obvious.

Defibrillator

Defibrillator STEMI Coronary ALS

Updates in the Management of Refractory Ventricular Tachycardia or Ventricular Fibrillation Arrest

ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. 2 Standard management for VT and VF involves the use of electrical defibrillation, high-quality chest compressions, and epinephrine. Tips for use of dual sequence defibrillation 11 : Use the same model of defibrillator.

Defibrillator

Defibrillator OR ALS Epinephrine

1 hour of CPR, then ECMO circulation, then successful defibrillation.

Dr. Smith's ECG Blog

MAY 19, 2020

She was unable to be defibrillated but was cannulated and placed on ECMO in our Emergency Department (ECLS - extracorporeal life support). After good ECMO flow was established, she was successfully defibrillated. Here is a case of ECMO defibrillation with near shark fin that was due to proximal LAD occlusion. The K was normal.

Defibrillator

Defibrillator CPR Coronary CAD

SGEM#394: Say Bye Bye Bicarb for Pediatric In-Hospital Cardiac Arrest

The Skeptics' Guide to EM

FEBRUARY 25, 2023

Case: A 6-month-old boy presents to the emergency department (ED) with three days of worsening cough, cold symptoms, and fever. Background: We often manage patients in cardiac arrest in the ED or the intensive care unit (ICU). Pediatric Crit Care Med. Parents note that he has been progressively more tired and difficult to arouse.

CPR

CPR ICU Critical Care Defibrillator

SGEM#314: OHCA – Should you Take ‘em on the Run Baby if you Don’t get ROSC?

The Skeptics' Guide to EM

JANUARY 9, 2021

JAMA 2020 Guest Skeptic: Mike Carter is a former paramedic and current PA practicing in pulmonary and critical care as well as an adjunct professor of emergency medical services […] The post SGEM#314: OHCA – Should you Take ‘em on the Run Baby if you Don’t get ROSC? Date: January 5th, 2021 Reference: Grunau et al.

EMS

EMS Emergency Medical Services CPR Critical Care

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The arrhythmia spontaneously converted before defibrillation was achieved. Those who make it to the ED usually have transient occlusions with reperfusion. Figure-1: Reasons for the varied ECG presentation of acute LMain occlusion — excerpted from Dr. Smith’s 8/9/2019 post ( This Table from My Comment in the January 16, 2020 post ).

Coronary

Coronary ACS Emergency Department Defibrillator

A 40-something presented after attempted prehospital resuscitation with persistent Ventricular Fibrillation

Dr. Smith's ECG Blog

JULY 14, 2023

A 40-something with persistent Ventricular Fibrillation presented after attempted prehospital resuscitation A 40-something with no previous cardiac history presented to the ED in persistent Ventricular Fibrillation after attempted prehospital resuscitation. Finally, head-up CPR (which was not used here), makes for better resuscitation.

E-9-1-1

E-9-1-1 Defibrillator CPR STEMI

Most EMS Terminology Comes Down to Initials, Abbreviations and Acronyms

NCOAE

AUGUST 12, 2022

20, 2020: Surfing Terminology and Slang: You Can’t Play BINGO Without the Lingo From Oct. 10, 2020: On Belay — Climbing Terminology and Slang From Oct. If you recall, we started out with some “gnarly” surfing terms, then we “tied in” to a conversation about climbing, finally pulling a “wet exit” on the language of paddling.

EMS

EMS EMT EMT Emergency Medical Technician

ToxCard: Second Generation Antipsychotic Overdose

EMDocs

NOVEMBER 19, 2024

2 If Torsade de Pointes develops, defibrillate the patient if unstable, give magnesium, and consider overdrive pacing. In: Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, eds. Published 2020. His roommate found an empty pill bottle on the floor next to him. 1 Class IA (e.g., procainamide), IC (e.g.,

Overdose

Overdose EMS Emergency Medical Services OR

Does this T wave pattern mean anything?

Dr. Smith's ECG Blog

OCTOBER 23, 2023

She was successfully revived after several rounds of ACLS including defibrillation and amiodarone. On arrival to the ED the patient was intubated with normal vital signs. By EMS report, open pill bottles were found nearby at the scene, including quetiapine, fluoxetine, hydroxyzine, and gabapentin.

ICU

ICU OR Defibrillator EMS

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." Int J Cardiol Heart Vasc 2020 3. Int J Cardiol Heart Vasc 2021 2. Aslanger et al. Lemkes et al. Eur Heart J 2018 4.

STEMI

STEMI Paramedic Coronary ALS

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 November 10, 2020 post — for PTA. The October 17, 2020 post — for a 70-year old woman with " Artifactual VT ".

Critical Care

Critical Care Defibrillator OR ALS

Cardiac Arrest. What does the ECG show? Also see the bizarre Bigeminy.

Dr. Smith's ECG Blog

APRIL 29, 2020

She was never defibrillated. I was texted this ECG in real time, but it turns out to actually be the 2nd one recorded in the ED. 3 of the 4 have similarly bizarre PVCs. == MY Comment by K EN G RAUER, MD ( 4/29/2020 ): == Cardiac Arrest with Bizarre PVCs/Torsades de Pointes: Intriguing case with many interesting features.

Defibrillator

Defibrillator Epinephrine Coronary Overdose

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

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

Hyperthermia and ST Elevation

Dr. Smith's ECG Blog

JANUARY 30, 2019

-- 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. Smith on this blog ( Simply search for Brugada Syndrome! ).

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

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

Dr. Smith's ECG Blog

FEBRUARY 17, 2023

Treatment is by ICD ( implantable cardioverter defibrillator ). The Importance of the History in Today’s Case: Hypercalcemia to at least a moderate degree (ie, serum calcium level >12 mg/dL ) is not a common diagnosis in an unselected ED population.

STEMI

STEMI Defibrillator OR ED

Paramedicine Now

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

Updates in the Management of Refractory Ventricular Tachycardia or Ventricular Fibrillation Arrest

Trending Sources

1 hour of CPR, then ECMO circulation, then successful defibrillation.

SGEM#394: Say Bye Bye Bicarb for Pediatric In-Hospital Cardiac Arrest

SGEM#314: OHCA – Should you Take ‘em on the Run Baby if you Don’t get ROSC?

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

A 40-something presented after attempted prehospital resuscitation with persistent Ventricular Fibrillation

Most EMS Terminology Comes Down to Initials, Abbreviations and Acronyms

ToxCard: Second Generation Antipsychotic Overdose

Does this T wave pattern mean anything?

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

Noisy, low amplitude ECG in a patient with chest pain

Cardiac Arrest. What does the ECG show? Also see the bizarre Bigeminy.

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

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

Hyperthermia and ST Elevation

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

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

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