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

JULY 22, 2023

Date: July 21, 2023 Reference: Prekker et al. Date: July 21, 2023 Reference: Prekker et al. We should focus more on high-quality CPR and early defibrillation for shockable rhythms and less on type of supraglottic airway device. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults.

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Emergency Medical Services Defibrillator CPR EMS 181

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Date: September 8th, 2021 Reference: Desch et al. Date: September 8th, 2021 Reference: Desch et al. Defibrillation is the treatment of choice in these cases but does not often result in sustained ROSC ( Kudenchuk et al 2006). The TOMAHAWK Investigators. first appeared on The Skeptics Guide to Emergency Medicine.

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Dr. Smith's ECG Blog

JULY 21, 2024

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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Defibrillator Coronary ALS STEMI 116

EMDocs

JANUARY 16, 2024

The patient received 1 mg of epinephrine IV x2 with conversion of his rhythm to ventricular fibrillation (VF) for which he was defibrillated twice in the field. The patient is moved over to the stretcher and connected to the monitors and defibrillator. What would your next steps be? His point-of-care labs return with a potassium of 3.4

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Defibrillator CPR Epinephrine Life Support 84

The Skeptics' Guide to EM

DECEMBER 7, 2018

Date: December 6th , 2018 Reference: Perkins et al. Date: December 6th , 2018 Reference: Perkins et al. A cardiac defibrillator is hooked up and the patient is in ventricular fibrillation. JAMA 2009, Hagihara et al. JAMA 2012 and Cournoyer et al. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest.

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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. Apart from high-quality CPR and early defibrillation, many other interventions we try lack a strong evidence base. Pediatric Crit Care Med. Pediatric Crit Care Med. But it’s not that straightforward.

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The Skeptics' Guide to EM

SEPTEMBER 29, 2018

[display_podcast] Date: September 21st, 2018 Reference: Kawano et al. display_podcast] Date: September 21st, 2018 Reference: Kawano et al. One defibrillation for ventricular fibrillation (VF) is provided but the patient remains in VF. EMS arrives on scene and initiates high quality basic life support (BLS).

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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. Bystander high-quality CPR can buy you some time until defibrillation. We know that rapid application of electricity to defibrillate shockable arrhythmias save lives.

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ACEP Now

JULY 7, 2023

Patients with a history of life-threatening or recurrent VT will often undergo radiofrequency catheter ablation and/or placement of a cardioverter defibrillator (implantable or external). Reference Anjeza Cipi MD, et al. Other treatments include electrical cardioversion and the use of antiarrhythmic drugs (e.g.,

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The Skeptics' Guide to EM

MARCH 2, 2019

Date: February 26th, 2019 Reference: Benger et al. Date: February 26th, 2019 Reference: Benger et al. Key to survival is high-quality CPR and early defibrillation. Reference: Benger et al, Effect of a Strategy of a Supraglottic Airway Device
vs. Effect of a Strategy of a Supraglottic Airway Device
vs.

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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.

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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.

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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. Optivol TM , measures thoracic impedance through an ICD or CRT-D device. arrhythmia).

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EMS 12-Lead

AUGUST 22, 2022

We can, therefore, put down the defibrillation pads, set aside the amiodarone, and look further at the ECG. A 12 Lead ECG was recorded secondary to bizarre telemetry findings at bedside. Said differently, it’s a mess. Paradoxically, though, the third green arrow identifies a QRS that is more narrow than the RBBB complexes surrounding it.

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REBEL EM

JUNE 1, 2023

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.

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Broome Docs

OCTOBER 31, 2022

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.

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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.

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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. There are no clear signs of OMI. The patient was admitted and put telemetry. While on telemetry monitoring he suffered cardiac arrest and was resuscitated. There is a prolonged QTc. There a two PVCs.

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EMDocs

SEPTEMBER 23, 2023

On arrival, vital signs are stable with a HR of 71, BP of 121/71 mmHg, RR of 17 bpm, and SpO2 of 97% on room air. Physical exam reveals a well-appearing female in no acute distress. Cardiac exam is unremarkable with normal S1/S2 without rubs, gallops or murmurs. Neurological exam is also unremarkable. Her presenting EKG is shown below.

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E-9-1-1 EMS ALS OR 84

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. Reference: Andersen et al. Cardiac Arrest: Pulselessness requiring chest compressions and/or defibrillation, with a hospital wide or unit based emergency response.

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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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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. Over the years, we as a scientific community have worked extensively to find other interventions that improve outcomes.

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NCOAE

AUGUST 12, 2022

That’s because one of our areas of focus here at The National Center for Outdoor & Adventure Education (NCOAE) is emergency medicine training and education. 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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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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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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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.

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Defibrillator E-9-1-1 ALS Epinephrine 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. Here is his triage ECG which was obtained at 20:34 during active pain. What do you think? This ECG was read as “No STEMI” with no prior available for comparison.

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STEMI ACS Coronary Defibrillator 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

They had difficulty describing their symptoms, but complained of severe weakness, nausea, vomiting, headache, and chest pain. They denied fever, cough, dyspnea, and sick contacts. They described the chest pain as severe, crushing, and non-radiating. It was not worse with exertion or relieved by rest. The case continues.

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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. She was on no medications. Potassium was normal.

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ECG Medical Training

DECEMBER 4, 2016

Let’s also not forget that these patients still require ventilation and they still require defibrillation! We use the LUCAS device, and there are other devices out there like the AutoPulse or the Thumper. I understand that others may have different opinions about mechanical CPR, and that’s fine with me. ” Two points here.

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ECG Medical Training

JUNE 11, 2016

Additional Treatments Defibrillation pads were applied. References Appelboam A, Reuben A, Mann C et al. Baker A, Whitbread M, Richmond L et al. A 12-lead ECG is obtained. There is a regular narrow complex tachycardia at a rate of 191. There are no visible P-waves. During the “strain phase” (A.) The Lancet.

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Dr. Smith's ECG Blog

MAY 6, 2019

This also is relevant — because of the m ale p redominance of Brugada Syndrome. 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.

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EMT Training Station

FEBRUARY 11, 2024

This equipment ranges from basic first aid supplies to sophisticated devices like defibrillators, oxygen therapy units, and advanced airway management tools. Advanced Medical Capabilities EMS teams are equipped with advanced medical equipment, enabling them to handle a wide variety of emergencies.

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ECG & Echo Learning

JANUARY 18, 2023

I B ECG monitoring should start immediately and a defibrillator must be ready. This page summarises the most current recommendations for the management of acute coronary syndromes with persistent ST-segment elevations (i.e STEMI , ST-segment elevation acute myocardial infarction ). due to reciprocal ST-segment depressions in V1, V2, V3).

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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".

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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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