EMDocs

JANUARY 8, 2024

With respect to timing, for cardiac arrest with a shockable rhythm, it may be reasonable to administer epinephrine after initial defibrillation attempts have failed. Consider administering epinephrine after defibrillation in those with shockable rhythms. COR 2b, LOE C-LD. COR 3, No benefit, LOE B-R. COR 2b, LOE B-R. COR 2b, LOE C-LD.

Epinephrine 98

Epinephrine Defibrillator Coronary CPR 98

Dr. Smith's ECG Blog

OCTOBER 28, 2013

She was found to be in ventricular fibrillation and was defibrillated 8 times without a single, even transient, conversion out of fibrillation. She was immediately intubated during continued compressions, then underwent a 9th defibrillation, which resulted in an organized rhythm at 42 minutes after initial arrest. References : 1.

Defibrillator 52

Defibrillator ACS CPR STEMI 52

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

But because Dr. Mastoras recognized the hyperacute T waves, the patient was immediately seen, the polymorphic VT was immediately defibrillated, and the patient was rapidly diagnosed and treated. The risk of SCAD is even higher in pregnancy — accounting for over 40% of angiograms performed for ACS during the peripartum period.

OR 67

OR STEMI ACS Coronary 67

Dr. Smith's ECG Blog

JUNE 19, 2023

During angiogram in the cath lab, the patient suffered two episodes of ventricular fibrillation for which he was successfully defibrillated. ST depression maximal in V1-V4, without a QRS abnormality clearly causing it, in the setting of ACS symptoms, is very concerning for posterior MI until proven otherwise.

STEMI 52

STEMI ACS Coronary Epinephrine 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation. If this is ACS with Aslanger's pattern , the ST depression vector of subendocardial ischemia (due to simultaneous 3 vessel or left main ACS) is directed toward lead II (inferior and lateral). CPR was initiated immediately.

ACS 52

ACS CPR CAD Heart Attack 52

EMT Training Station

FEBRUARY 11, 2024

Assessing the Severity The severity of an electrical burn depends on several factors: the type of current (AC or DC), voltage, the pathway of the current through the body, the duration of contact, and the victim’s overall health. As EMTs, we’re always prepared to address these life-threatening complications alongside the burns.

EMT 98

EMT EMT Emergency Medical Technician First Aid 98

Dr. Smith's ECG Blog

OCTOBER 20, 2013

She was never seen to be in ventricular fibrillation and was never defibrillated. Medics found her apneic and pulseless, began CPR, and she was found to be in asystole. With ventilations and epinephrine, she regained a pulse. She was hypotensive in the ED and her bedside echo showed a normal RV and LV. BP gradually rose.

STEMI 52

STEMI Coronary ACS Emergency Department 52

Dr. Smith's ECG Blog

SEPTEMBER 20, 2018

One must always be careful when looking for "baseline" ECGs, because the prior ECG on file may have been during another ACS event, as this one clearly was. He was defibrillated immediately and had return of normal mental status. Cath lab activation was cancelled but the transfer was accepted for urgent cardiology evaluation.

STEMI 52

STEMI Coronary ACS Defibrillator 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

The fire department, who operate at an EMT level in this municipality, arrived before us and administered 324 mg of baby aspirin to the patient due to concern for ACS. She was defibrillated and resuscitated. Most studies examine undifferentiated ACS cohorts, with only a handful providing separate data. References: 1.

Emergency Department 52

Emergency Department E-9-1-1 Coronary STEMI 52

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. He was treated medically for ACS and did not get an angiogram within 72 hours. The patient was defibrillated, and then taken to the nearest ED where ECG #1 was obtained ( Figure-1 ).

STEMI 52

STEMI Defibrillator ED ACS 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

Recall that, in the setting of ACS symptoms, ST depression that are maximal in leads V1-V4 (as opposed to V5 and V6) not attributable to an abnormal QRS complex is specific for OMI. When the ICD was finally interrogated, the syncopal events and shocks correlated with two VF events that were defibrillated successfully.

ACS 52

ACS Coronary Defibrillator STEMI 52

Dr. Smith's ECG Blog

OCTOBER 26, 2020

12 minutes later, the patient went back into VFib arrest and underwent another 15 minutes of resuscitation followed by successful defibrillation and sustained ROSC. In total, he received approximately 40 minutes of CPR and 7 defibrillation attempts. That said, ACS is by far the most common and treatable cause.

Coronary 40

Coronary Defibrillator ACS CAD 40

ECG & Echo Learning

JANUARY 18, 2023

I B ECG monitoring should start immediately and a defibrillator must be ready. I C Glucose-lowering therapy should be considered in ACS patients with glucose levels >10 mmol/L (>180 mg/dL), while episodes of hypoglycaemia (defined as glucose levels <_3.9 STEMI , ST-segment elevation acute myocardial infarction ).

STEMI 40

STEMI Coronary OR Defibrillator 40

ACEP Now

NOVEMBER 7, 2023

Multiple attempts at defibrillation, epinephrine, and amiodarone have been unsuccessful. Problem What is the best defibrillation strategy to treat refractory ventricular fibrillation? 2,3 Multiple published studies have addressed treatment of ventricular fibrillation with defibrillation and medications such as amiodarone and lidocaine.

Defibrillator 52

Defibrillator E-9-1-1 ALS Epinephrine 52

Dr. Smith's ECG Blog

DECEMBER 31, 2024

But thankfully, when the clinical context is clearly and highly concerning for ongoing ischemia from ACS, this distinction doesn't matter much. Soon after the witnessed occlusion, the patient suffered ventricular fibrillation arrest, from which he was immediately resuscitated with 1 defibrillation.

Coronary 119

Coronary ACS STEMI CAD 119

Dr. Smith's ECG Blog

MARCH 25, 2025

In ACS, chest pain is the warning sign of ongoing ischemia. In this case, you should get a second defibrillator and perform double sequential external defibrillation (DSED). Simply attach a second defibrillator as shown in the diagram below and deliver max shocks from both devices simultaneously.

Defibrillator 63

Defibrillator ACS Coronary ALS 63

Dr. Smith's ECG Blog

MARCH 8, 2025

Several 200 J shocks did not terminate the VF, so a second defibrillator was applied for double sequential defibrillation with 400 J. She was defibrillated perhaps 25 times. After completing the ACS algorithm with amiodarone and lidocaine, there are diminishing returns on further treatments. SanzRuiz, R., Solis, J., &

E-9-1-1 76

E-9-1-1 OR Defibrillator Coronary 76

Dr. Smith's ECG Blog

DECEMBER 27, 2024

After ruling out for ACS, the patient underwent angiography where he was found to have severe stable disease, which was already known. This would be approximately 95% of the patient's maximum predicted sinus rate. This demands an explanation -- sepsis, hemorrhage, withdrawal, etc. Calling sinus tachycardia raises more questions than answers.

Coronary 121

Coronary Defibrillator ACS ED 121

Dr. Smith's ECG Blog

FEBRUARY 2, 2025

He had several older ECGs on file, here are two examples: 6 days prior: 2 months prior: In the context of ACS symptoms, and when able to compare the new vs. old ECG, the top ECG is DIAGNOSTIC of OMI until proven otherwise. Defibrillation was performed, and ROSC was achieved.

STEMI 87

STEMI Defibrillator ACS OR 87

Dr. Smith's ECG Blog

FEBRUARY 6, 2025

Whenever I see PVCs with the morphology and axis seen in todays case I always look for signs of AC ( Arrhythmogenic Cardiomyopathy ). See this case for an in-depth discussion of AC and an example of VT and ECG changes associated with this disorder. Arrhythmogenic cardiomyopathy often manifests with PVCs from the RV.

Plasma 73

Plasma ACS OR Coronary 73