Dr. Smith's ECG Blog

JULY 14, 2023

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 98

E-9-1-1 Defibrillator CPR STEMI 98

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

This episode self terminated before defibrillation was possible. See Costagliola et al — Ann Clin Transl Neurol 8(7): 1557-1568, 2021 — for more on the complex "Brain-Heart Interaction" in Epilepsy ). This run of TdP is initiated by a PVC — but it then self-terminates. Discussion : The patient in today’s case presented with "seizures".

E-9-1-1 113

E-9-1-1 ALS Defibrillator OR 113

Dr. Smith's ECG Blog

JUNE 14, 2024

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 ). Additional review of ECG artifacts by Pérez-Riera et al ( Ann Noninvasic Electrocardiol 23:e12494, 2018 ) VT Artifact — by Knight et al: NEJM 341:1270-1274, 1999.

Defibrillator 81

Defibrillator ALS Coronary OR 81

Dr. Smith's ECG Blog

JUNE 21, 2023

Two hours later , the patient returned to this same urgent care facility with worsening chest pain, and this ECG was performed: While getting another ECG, the patient suffered cardiac arrest: After multiple defibrillations, ROSC was achieved with ongoing "STEMI". Most OMI have a peak Troponin T over 1000 ng/L [reference: Baro R et al.

STEMI 98

STEMI Coronary Defibrillator EMS 98

EMDocs

FEBRUARY 9, 2024

Adapted from Dr. Smith’s EKG Blog. Defibrillator pads are placed and you give 2 g IV magnesium over ten minutes. Figure 3/ Adapted from Wilde et al. A complete approach to treating cLQTS can be found in Wilde et al 2. An ECG is performed and is shown below: Figure 1. The patient is awake and protecting her airway.

Defibrillator 96

Defibrillator OR ED ALS 96

Dr. Smith's ECG Blog

JANUARY 23, 2024

She was given CRT-D (Cardiac Resynchronization Therapy-Defibrillator). Learning points: == MY Comment , by K EN G RAUER, MD ( 1/15 /2024 ): == Today's case by Dr. Nossen differs from other cases of AV block we have published over the years in Dr. Smith's ECG Blog — in that the cause of AV block turned out to be CS ( C ardiac S arcoidosis ).

Coronary 107

Coronary OR Defibrillator ALS 107

REBEL EM

SEPTEMBER 19, 2022

Background: There are only two interventions that have been proven in the medical literature to improved outcomes in cardiac arrest: high-quality CPR and early defibrillation. Article: Moore JC et al. References: Moore JC et al. It is imperative that we continue to look at ways to improve cardiac arrest resuscitation.

CPR 52

CPR Defibrillator EMS Epinephrine 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2024

After resuscitation and defibrillation , there were no more episodes of TdP. Below is the patient’s 12 lead ECG following defibrillation. Most Torsades is the result of a pause-dependent effect that predisposes to development of the malignant arrhythmia ( Dohadwala et al — Heart Rhythm Case Rep 3(2):115-119, 2017 ).

Defibrillator 67

Defibrillator Coronary OR ALS 67

Dr. Smith's ECG Blog

JANUARY 15, 2024

ECG 2 Especially in the context of the first ECG, readers of this blog will readily appreciate the ST elevations and hyperacute T waves in II, III, aVF, V6, and to a lesser extent V5. As discussed on this blog many times before, proportionality is key to the diagnosis of OMI by ECG. [link] I also texted the ECG to Dr. Smith.

Critical Care 64

Critical Care Defibrillator OR ALS 64

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. see below).

Defibrillator 52

Defibrillator ACS CPR STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

She was defibrillated and resuscitated. Reference on Troponins: Xenogiannis I, Vemmou E, Nikolakopoulos I, et al. Lindahl et al. From Gue at al. Lindahl B, Baron T, Erlinge D, et al. Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Emergency Department 52

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

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. Rituparna et al — as well as Chauhan and Brahma ( Int. On arrival, CPR was continued and core temperature was measured at 18° C (64.4° This is an Osborn wave.

CPR 40

CPR Defibrillator Life Support ED 40

Dr. Smith's ECG Blog

FEBRUARY 13, 2023

Meyers et al. Aslanger et al. Lemkes et al. Bergmark et al. There was 100% proximal LAD occlusion, EF was 55% with severe hypokinesis to mid-distal septum and apex. First troponin I was 150 ng/L (normal <26 in males and <16 in females) and peak was 7,500. Int J Cardiol Heart Vasc 2021 2. Eur Heart J 2018 4.

STEMI 52

STEMI Paramedic Coronary ALS 52

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.

ALS 52

ALS Defibrillator OR ED 52

Dr. Smith's ECG Blog

JUNE 19, 2023

Armstrong et al. During angiogram in the cath lab, the patient suffered two episodes of ventricular fibrillation for which he was successfully defibrillated. We have tried to study it before, only to find that we cannot obtain enough cases of OMI with simultaneous high voltage in the leads with OMI findings, to study it.

STEMI 52

STEMI ACS Coronary Defibrillator 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

In the largest study looking at this topic by Mizusawa et al., Recently the rate of true arrhythmic events related to fevers in the classic Brugada Type 1 syndrome was explored by Michowitz et al. 88 patients with fever induced Brugada Type 1 ECG changes without history of syncope or VF/VT were analyzed. There was a 0.9%

E-9-1-1 52

E-9-1-1 CAD STEMI OR 52

Dr. Smith's ECG Blog

OCTOBER 20, 2013

She was never seen to be in ventricular fibrillation and was never defibrillated. Kurkciyan et al. Kurkciyan et al., Medics found her apneic and pulseless, began CPR, and she was found to be in asystole. With ventilations and epinephrine, she regained a pulse. BP gradually rose. Of these, ischemic ST depression was found in 52%.

STEMI 52

STEMI Coronary ACS Emergency Department 52

Dr. Smith's ECG Blog

MAY 6, 2019

Excerpted from Vutthikraivit et al: Acta Cardiol Sin 34:267-277, 2018 ). == Distinction is made between 2 types of Brugada ECG patterns: A B rugada - 1 ECG pattern — shows ≥2 mm coved ST elevation with sharp downslope plus T wave inversion in ≥2 anterior leads. Cardioversion/defibrillation. Acute febrile illness. Hypothermia.

STEMI 52

STEMI Defibrillator OR ALS 52

Dr. Smith's ECG Blog

APRIL 8, 2016

At cath, he immediately had incessant Torsades de Pointes requiring defibrillation 7 times and requiring placement of a transvenous pacer for overdrive pacing at a rate of 80. the associated loss is double, at 200-400 mEq.* [ Sterns RH, et al. He was given amiodarone and lidocaine load and drip and K and Mg drips.

STEMI 52

STEMI Plasma Defibrillator OR 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

the associated loss is double, at 200-400 mEq.* [ Sterns RH, et al. Here are other posts on hyperK, large calcium doses for hyperK, and ventricular tachycardia in hyperK Weakness, prolonged PR interval, wide complex, ventricular tachycardia Very Wide and Very Fast, What is it? How would you treat? Medicine (Baltimore) 1981;60:339-54].

Plasma 40

Plasma STEMI Defibrillator Overdose 40

Dr. Smith's ECG Blog

DECEMBER 5, 2019

Bayes de Luna, A et al. This is based on the Sieira et al, 2017, risk calculator , which gives a borderline risk score (2). An EP study might be helpful in symptomatic patients (Sroubek et al., Current electrocardiographic criteria for diagnosis of Brugada pattern: a consensus report. J Electrocardiology 45 (2012):433-442.

ALS 52

ALS OR Defibrillator STEMI 52

Dr. Smith's ECG Blog

DECEMBER 22, 2010

After epinephrine, atropine, and defibrillation x 2, there was a return of pulses. Plummer D et al. A 65 yo woman had felt ill for 36 hours, had seen her MD but without undergoing a cardiac evaluation. She collapsed and 911 was called; she was found pulseless. Exact rhythm during arrest is uncertain.

STEMI 40

STEMI Defibrillator Epinephrine Emergency Department 40

Dr. Smith's ECG Blog

MARCH 25, 2025

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. Many similar cases have been featured on the blog.

Defibrillator 63

Defibrillator ACS Coronary ALS 63

Dr. Smith's ECG Blog

DECEMBER 20, 2024

This is the shock coil and identifies this device as a defibrillator. CRT-D is cardiac resynchronization therapy with defibrillation capability, like the CXR above. CRT-P is cardiac resynchronization therapy with pacing only, without the ability to defibrillate. Kaye et al. Canepa-Anson et al.

Defibrillator 102

Defibrillator Coronary ALS Emergency Department 102

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

Although we lack details of events that followed Dr. Smith makes the key point that had this arrest witnessed by the medic team been the result of an acute cardiac event ( therefore, presumably VT or VFib ) prompt defibrillation by on-the-scene medics would most probably have resuscitated her.

STEMI 88

STEMI Paramedic E-9-1-1 Epinephrine 88

FOAMfrat

DECEMBER 31, 2024

Essentially, to put this blog to rest You will treat the patient the same as any other patient. With that being said, the manufacturers say that CPR, medications, Defibrillation, Cardioversion, and Anything you would normally do are OKAY. We still defibrillate ventricular fibrillation just as we would any other patient.

CPR 64

CPR Defibrillator Emergency Department Emergency Transportation 64

Dr. Smith's ECG Blog

FEBRUARY 6, 2025

The intricacies of the different classes of antiarrhythmics and their mechanism of action extend beyond the scope of this blog. I list below links to other cases of idiopathic VT from Dr Smith's ECG blog. Try a different kind of antiarrhythmic. This is what was done in today's case. 2022, September 2) [2] Ward, R. Van Zyl, M., &

Plasma 72

Plasma ACS OR Coronary 72