The Skeptics' Guide to EM

OCTOBER 24, 2020

Reference: Derkenne et al. Reference: Derkenne et al. You abandon your coffee order and quickly head next-door, where you are able to start cardiopulmonary resuscitation (CPR) and direct a bystander to find the store’s automated external defibrillator (AED) while waiting for emergency medical services (EMS) to arrive.

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The Skeptics' Guide to EM

DECEMBER 7, 2018

Date: December 6th , 2018 Reference: Perkins et al. Date: December 6th , 2018 Reference: Perkins et al. You are the first provider on scene with Emergency Medical Services (EMS) and start high-quality Cardiopulmonary Resuscitation (CPR). A cardiac defibrillator is hooked up and the patient is in ventricular fibrillation.

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The Skeptics' Guide to EM

SEPTEMBER 29, 2018

[display_podcast] Date: September 21st, 2018 Reference: Kawano et al. Annals of EM May 2018 Guest Skeptic: Andrew Merelman is a critical care paramedic and first year medical student at Rocky Vista University in Colorado. display_podcast] Date: September 21st, 2018 Reference: Kawano et al.

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BLS Defibrillator Critical Care CPR 130

The Skeptics' Guide to EM

SEPTEMBER 23, 2017

[display_podcast] Date: September 19th, 2017 Reference: Cournoyer et al. display_podcast] Date: September 19th, 2017 Reference: Cournoyer et al. You need to recognize an arrest and activate your EMS system. Bystander high-quality CPR can buy you some time until defibrillation. JAMA 2009 * Jacobs et al.

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The Skeptics' Guide to EM

MARCH 11, 2023

Date: March 8, 2023 Reference: Smida et al. Date: March 8, 2023 Reference: Smida et al. Prehospital Emergency Care 2023 Guest Skeptic: Dr. He is a former New York City paramedic and this summer will be starting fellowship training in EMS medicine at UNM. Reference: Smida et al.

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ACEP Now

JULY 7, 2023

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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Defibrillator OR ALS Epinephrine 98

EMDocs

SEPTEMBER 23, 2023

We’ll keep it short, while you keep that EM brain sharp. 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. Rosh Review Website Link References Antzelevitch C, Brugada P, Borggrefe M, et al.

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The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Date: September 8th, 2021 Reference: Desch et al. Guest Skeptic: Dr. Stephen Meigher is the EM Chief Resident training with the Jacobi and Montefiore Emergency Medicine Residency Training Program. Date: September 8th, 2021 Reference: Desch et al. The TOMAHAWK Investigators. The TOMAHAWK Investigators.

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EMR Coronary Defibrillator Life Support 130

Dr. Smith's ECG Blog

JANUARY 2, 2025

Bogossian et al. (1) Bogossian H, Frommeyer G, Ninios I, Hasan F, Nguyen QS, Karosiene Z, Mijic D, Kloppe A, Suleiman H, Bandorski D, et al. Dodd KW, Elm KD, Dodd EM, Smith SW. However, in order to correct for rate , one needs a full QT interval. Then we can correct that modified QT for heart rate. Heart Rhythm [Internet].

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Coronary OR Defibrillator ALS 116

The Skeptics' Guide to EM

MARCH 2, 2019

Date: February 26th, 2019 Reference: Benger et al. Date: February 26th, 2019 Reference: Benger et al. Case: EMS arrive to your emergency department with a 68-year-old man post cardiac arrest patient. Key to survival is high-quality CPR and early defibrillation. Effect of a Strategy of a Supraglottic Airway Device
vs.

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CPR Firefighter Paramedic Epinephrine 130

Paramedics Unlimited

APRIL 19, 2018

What is the difference between ALS and BLS Medical Care? In Basic Life Support (BLS) emergencies, a single EMS provider can not deliver optimum care, such as when trying to hold direct pressure on a bleeding wound, while preparing bandages, to stop bleeding.

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BLS ALS Emergency Medical Technician Advanced Life Support 52

EMT Training Station

FEBRUARY 11, 2024

In the realm of emergency healthcare, the terms EMS (Emergency Medical Services) and EMT (Emergency Medical Technician) are often used interchangeably, yet they represent distinct aspects of medical response and care. Though they are closely related and often work together, EMS and EMT have distinct roles, training, and responsibilities.

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EMDocs

JANUARY 16, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University in St. Louis); Dr. Jessica Pelletier, DO (EM Attending Physician, Washington University in St. You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Per EMS he was very cold to touch.

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Defibrillator CPR Epinephrine Life Support 109

Dr. Smith's ECG Blog

JUNE 21, 2023

EMS was called, and they recorded the following ECG on scene at 13:16: What do you think? 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. In this case, the EMS provider was routed to the urgent care facility.

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STEMI Coronary Defibrillator EMS 98

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. 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.

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Defibrillator Coronary ALS STEMI 131

The Skeptics' Guide to EM

DECEMBER 2, 2017

[display_podcast] Date: November 24th, 2017 Reference: Andersen et al. display_podcast] Date: November 24th, 2017 Reference: Andersen et al. SGEM#64 : Classic EM Papers (OPALS Study) * SGEM#136 : CPR – Man or Machine? Reference: Andersen et al.

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CPR Defibrillator ALS Emergency Response 100

REBEL EM

JUNE 1, 2023

Article: Branch KHR et al. Known cardiac defibrillator. References: Branch KHR et al. appeared first on REBEL EM - Emergency Medicine Blog. In theory, rapid identification of the underlying cause should improve outcomes by allowing clinicians to tailor management. Resus 2023. Pre-existing DNR order. Resus 2023.

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NCOAE

AUGUST 12, 2022

Today we’re taking a more serious look at language, this time highlighting the terminology used by members of the Emergency Medical Service (EMS) community. The post Most EMS Terminology Comes Down to Initials, Abbreviations and Acronyms appeared first on National Center for Outdoor & Adventure Education.

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EMS EMT EMT Emergency Medical Technician 52

EMS 12-Lead

AUGUST 22, 2022

We can, therefore, put down the defibrillation pads, set aside the amiodarone, and look further at the ECG. Paradoxically, though, the third green arrow identifies a QRS that is more narrow than the RBBB complexes surrounding it. Question 2: What explains the conduction abnormalities? References Chiale, P. JACC, Vol 23, No 3; 724-32.

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EMDocs

FEBRUARY 9, 2024

Authors: Adam Roussas, MD, MBA, MSE // Reviewed by: Jamie Santistevan, MD ( @jamie_rae_EMdoc, EM Physician, Presbyterian Hospital, Albuquerque, NM); Manpreet Singh, MD ( @MPrizzleER ); and Brit Long, MD ( @long_brit ) Case A 40-year-old female presents to the emergency department for palpitations and lightheadedness. She denies chest pain.

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Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

Her husband called EMS when the patient experienced new onset seizures accompanied by micturition. The ECG below was recorded by EMS. This episode self terminated before defibrillation was possible. Written by Magnus Nossen — with edits by Grauer. The patient in today’s case is a 30-something female. What is your assessment?

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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. Population: Patients > 18 years of age w/ OHCA treated by 10 EMS systems in in the US. However, human data is sorely lacking.

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Broome Docs

OCTOBER 31, 2022

PMID: 34904190 Not surprisingly, this paper has been covered by basically everyone who talks about research, so if you want to hear some other opinions, check out the SGEM , REBEL EM , or St. The PEACH trial: No body had a fit, so… we have no clue Peter-Derex L, Philippeau F, Garnier P, et al. 2018 Sep 11;362:k3843. N Engl J Med.

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ECG Medical Training

JUNE 11, 2016

EMS is called to the clubhouse of a golf course for a female patient in her early 50s complaining of palpitations. She had just finished playing 18 holes when her “heart started racing” She has a history of supraventricular arrhythmias and reportedly attempted vagal maneuvers prior to EMS arrival without success.

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Paramedic Defibrillator ALS Emergency Department 52

ECG Medical Training

DECEMBER 4, 2016

Alongside tracheal intubation , response times , and fire-based EMS, this is one of the most controversial topics in prehospital medicine. This is important because too many EMS systems look at mechanical CPR as a way to avoid having to become experts in resuscitation or having to send additional resources to the scene.

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CPR E-9-1-1 Defibrillator Ambulance 52

NAEMSP

APRIL 19, 2023

CPR is taken over by responding crews, and he is placed on a cardiac monitor/defibrillator. After several cycles of defibrillation, epinephrine, and amiodarone, the patient remains in cardiac arrest. Current AHA guidelines do not recommend routine use of calcium in cardiac arrest (Panchal, et al.,

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E-9-1-1 Advanced Life Support Overdose CPR 52

Dr. Smith's ECG Blog

FEBRUARY 13, 2023

Meyers et al. Aslanger et al. Lemkes et al. Bergmark et al. Today's patient is a 70-year old adult who called EMS because of new-onset chest pain , associated with nausea and shortness of breath. There was 100% proximal LAD occlusion, EF was 55% with severe hypokinesis to mid-distal septum and apex.

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.

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ALS Defibrillator OR ED 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. She was defibrillated and resuscitated. Lindahl et al.

Emergency Department 52

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

Dr. Smith's ECG Blog

JANUARY 30, 2019

She was ventilated by bag-valve-mask by EMS on arrival and was quickly intubated with etomidate and succinylcholine. 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.

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ACEP Now

NOVEMBER 7, 2023

EMS physicians report he was found in ventricular fibrillation. Multiple attempts at defibrillation, epinephrine, and amiodarone have been unsuccessful. Problem What is the best defibrillation strategy to treat refractory 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

1 Like other implantable devices, such as pacemakers and automated implantable cardioverter defibrillators (AICDs), they can be interrogated for valuable information by the patient ’ s cardiology team when the patient presents to the ED. Angermann CE, Assmus B, Anker SD, et al. Brugts JJ, Radhoe SP, Clephas PRD, et al.

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REBEL EM

DECEMBER 19, 2022

Background Information: Double external defibrillation (DED) is an intervention often used to treat refractory ventricular fibrillation (RVF). This procedure involves applying another set of pads attached to a second defibrillator to a patient and shocking them in hopes of terminating the rhythm. N Engl J Med.

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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. Annals of EM 23(6):1333-1342; June 1994. 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.

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STEMI Epinephrine Defibrillator Emergency Department 40

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

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.

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STEMI Paramedic E-9-1-1 Epinephrine 89

FOAMfrat

DECEMBER 31, 2024

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. EMS Left Ventricular Assist Device Management. 99% of the time, they have statistically few problems.

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CPR Defibrillator Emergency Department Emergency Transportation 64

ACEP Now

OCTOBER 29, 2024

EMS found the patient pulseless and apneic, with an initial rhythm showing ventricular fibrillation (see figure 1). He was defibrillated twice and received two doses of epinephrine, with return of spontaneous circulation. Figure 1: The EMS rhythm strip. References Sangwatanaroj S, Prechaway S, Sunsaneewitayakul B, et al.

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