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Journal Feed Weekly Wrap-Up

EMDocs

1: Hypertensive Crisis Averted…New AHA Statement on Asymptomatic Hypertension Spoon Feed This article emphasizes the difference between hypertensive emergency and asymptomatic elevated blood pressure (BP); while hypertensive emergency requires prompt treatment to lower BP, treatment of asymptomatic elevated BP in acute care settings may be harmful.

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

ACEP Now

2 Standard management for VT and VF involves the use of electrical defibrillation, high-quality chest compressions, and epinephrine. Initial guidelines defined “refractory” as VT or VF occurring despite three shocks from a cardiac defibrillator. Tips for use of dual sequence defibrillation 11 : Use the same model of defibrillator.

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What are treatment options for this rhythm, when all else fails?

Dr. Smith's ECG Blog

He required multiple defibrillations within a period of a few hours. This time, the arrhythmia did not spontaneously terminate — but rather degenerated to VFib, requiring defibrillation. Some episodes of PMVT would terminate spontaneously — but on many occasions, the PMVT degenerated to VFib, requiring defibrillation.

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

Dr. Smith's ECG Blog

He underwent further standard resuscitation EXCEPT that we applied the Inspiratory Threshold Device ( ResQPod ) AND applied Dual Sequential Defibrillation (this simply means we applied 2 sets of pads, had 2 defib machines, and defibrillated with both with only a fraction of one second separating each defibrillation.

E-9-1-1 93
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First10EM Journal Club: October 2022

Broome Docs

The PEACH trial: No body had a fit, so… we have no clue Peter-Derex L, Philippeau F, Garnier P, et al. PMID: 30206143 Less is more when it comes to intravenous fluids de-Madaria E, Buxbaum JL, Maisonneuve P, et al. PMID: 35490863 Hands on defibrillation: Even if it’s safe, would it actually help? N Engl J Med.

E-9-1-1 52
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The CT FIRST Trial: Should We Pan-CT After ROSC?

REBEL EM

Article: Branch KHR et al. Known cardiac defibrillator. References: Branch KHR et al. In theory, rapid identification of the underlying cause should improve outcomes by allowing clinicians to tailor management. Advanced imaging post-arrest is a possible modality to achieve this end. Resus 2023. Pre-existing DNR order.

Coronary 145
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Palpitations while awaiting CABG

Dr. Smith's ECG Blog

But artifact is "alive and well" — and learning to recognize it will amaze many of your colleagues ( and may serve to avoid an unnecessary defibrillation or two ). The September 27, 2019 post — for the Rowlands & Moore article with the above-noted formulas for recognizing the “culprit” extremity. More VT-VFib artifact — CLICK HERE.