The Skeptics' Guide to EM

FEBRUARY 25, 2023

Reference: Cashen K, Reeder RW, Ahmed T, et al. Reference: Cashen K, Reeder RW, Ahmed T, et al. 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).

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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.

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Defibrillator CPR Epinephrine Life Support 106

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. References Chiale, P. JACC, Vol 23, No 3; 724-32.

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ACEP Now

DECEMBER 6, 2024

After the fourth defibrillation attempt, 200 mcg IV NTG was administered, resulting in immediate return of spontaneous circulation with a junctional bradycardia rhythm. Dr. Rad is ED faculty at Wellstar Kennestone Regional Medical Center in Marietta, Ga., References Prinzmetal M, Kennamer R, Merliss R, et al. Click to enlarge.)

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Coronary Life Support ALS Emergency Department 98

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.

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E-9-1-1 Defibrillator CPR STEMI 98

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. Most OMI have a peak Troponin T over 1000 ng/L [reference: Baro R et al. In this case, the EMS provider was routed to the urgent care facility.

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STEMI Coronary Defibrillator EMS 98

EMDocs

FEBRUARY 9, 2024

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. It is recommended to use an unsynchronized setting as the defibrillator may not be able to track the R-wave in the polymorphic waveform.

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Defibrillator OR ED ALS 93

EMDocs

SEPTEMBER 23, 2023

A 36-year-old female presents to the ED after experiencing an episode of sudden syncope. Patients with Brugada syndrome should have a prompt cardiology consultation for consideration of implantable defibrillator placement due to the high risk of sudden cardiac death. Priori SG, Napolitano C, Gasparini M, et al. Circulation.

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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.

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ALS ED OR 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 arrived in the ED 37 minutes after 911 was called, with continuing CPR. She arrived in the ED 37 minutes after 911 was called, with continuing CPR. at the time of the ECG.

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Defibrillator ACS CPR STEMI 52

NCOAE

AUGUST 12, 2022

Here, we present them in alphabetical order: ABC – Airway, Breathing and Circulation – “This is the Golden Rule of emergency medical professionals” AED – Automated External Defibrillator – The device that delivers electric shock to the heart of patients experiencing sudden cardiac arrest A-EMT – Advanced EMT ALS – Advanced Life Support Anaphylaxis— (..)

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EMS EMT EMT Emergency Medical Technician 52

Broome Docs

JANUARY 30, 2023

Defibrillation Strategies for Refractory Ventricular Fibrillation. Vedantham S, Goldhaber SZ, Julian JA, et al; ATTRACT Trial Investigators. DOSE VF: Cheskes S, Verbeek PR, Drennan IR, McLeod SL, Turner L, Pinto R, Feldman M, Davis M, Vaillancourt C, Morrison LJ, Dorian P, Scales DC. N Engl J Med. 2022 Nov 6. Epub ahead of print.

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E-9-1-1 Defibrillator Emergency Department ALS 52

Dr. Smith's ECG Blog

OCTOBER 20, 2013

She was never seen to be in ventricular fibrillation and was never defibrillated. She was hypotensive in the ED and her bedside echo showed a normal RV and LV. Two prehospital 12-lead ECGs looked similar to this ED ECG: This shows diffuse ST depression (I, II, III, aVL, aVF, V3-V6) with reciprocal ST elevation in lead aVR.

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STEMI Coronary ACS Emergency Department 52

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." Meyers et al. Aslanger et al. Lemkes et al. Bergmark et al. Int J Cardiol Heart Vasc 2021 2.

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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. Methods. . =

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ALS Defibrillator OR ED 52

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. Figure-2: TOP: ECG Brugada-1 and Brugada-2 patterns ( from Bayés de Luna et al: J. Could this be a coincidence that the patient was experiencing chest pain and upon ECG capture the atypical brugada pattern was found?

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STEMI Defibrillator OR ALS 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. This Transesophageal ED Echo was recorded: Cardiac POCUS.mov from Stephen Smith on Vimeo. Rituparna et al — as well as Chauhan and Brahma ( Int.

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CPR Defibrillator Life Support ED 40

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. Rhythm A: This rhythm strip was observed on telemetry — and thought to be AFlutter. The January 30, 2018 post — for PTA.

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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."

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

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E-9-1-1 CAD STEMI OR 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

They transported to the ED. The history, obtained subsequently, is interesting: The patient had been seen at an outside ED 2 days prior and the K was 2.5 Hospital admission had been recommended, but she left that ED against medical advice. the associated loss is double, at 200-400 mEq.* [ Sterns RH, et al.

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Plasma STEMI Defibrillator Overdose 40

Dr. Smith's ECG Blog

APRIL 8, 2016

Here is his ED ECG: There is obvious infero-posterior STEMI. 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.

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STEMI Plasma Defibrillator OR 52

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.

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Defibrillator E-9-1-1 ALS Epinephrine 52

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.

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Defibrillator Allergic Reaction ED ALS 108

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). If there are any syncopal or presyncopal events, she should be evaluated immediately in the ED. --All An EP study might be helpful in symptomatic patients (Sroubek et al., Heart Rhythm 2016.

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ALS OR Defibrillator STEMI 52

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

This is what the providers in the ED understood on patient arrival: Patient called 911 for syncope, then had witnessed PEA arrest after medics arrived. She was brought to the ED in a deep coma with GCS of 3, with vital signs, and an ECG was recorded: What do you think? Not a shockable rhythm. including epinephrine, and there was ROSC.

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STEMI Paramedic E-9-1-1 Epinephrine 89

Dr. Smith's ECG Blog

FEBRUARY 6, 2025

During observation in the ED the patient had multiple self-terminating runs of Non-Sustained monomorphic Ventricular Tachycardia (NSVT). The ECG in Figure-1 however, shows no signs of arrhythmogenic cardiomyopathy. See this case for an in-depth discussion of AC and an example of VT and ECG changes associated with this disorder. Van Zyl, M.,

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