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.

Emergency Medical Services 222

Emergency Medical Services Defibrillator CPR EMS 222

St. Emlyn's

OCTOBER 21, 2024

St.Emlyn's - Emergency Medicine #FOAMed Should we use AP or AL pad position first for defibrillation in VF/VT cardiac arrest. FOAMed @stemlyns The post AP or AL pad position for first choice shock in VF? appeared first on St.Emlyn's.

ALS 52

ALS OR Defibrillator 52

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. T-waves are quite tall and possibly peaked (HyperK?), but potassium returned normal. What is the QT interval? In LBBB, the QT interval is partly prolonged by the wide QRS. Heart Rhythm [Internet].

Coronary 117

Coronary OR Defibrillator ALS 117

EMDocs

NOVEMBER 19, 2024

10 Table 1: Second-Generation Antipsychotics and Associated Adverse Effects Adapted from: UpToDate 8 with additional sources Micromedex 9 and Riboldi, et al 11 *SL=sublingual, IM=intramuscular, PO=oral, ODT=orally disintegrating tablets, ER=extended release, IR=immediate release. +to 1 Seizures may occur due to lowered seizure threshold.

Overdose 108

Overdose EMS Emergency Medical Services ALS 108

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.

CPR 130

CPR Defibrillator Advanced Life Support Emergency Medical Services 130

The Skeptics' Guide to EM

OCTOBER 22, 2022

Date: October 18th, 2022 Reference: Moore et al. Date: October 18th, 2022 Reference: Moore et al. This includes epinephrine for OHCA, target temperature management, mechanical CPR, supraglottic airways, steroids, hands on defibrillation and many more topics. first appeared on The Skeptics Guide to Emergency Medicine.

CPR 130

CPR Defibrillator Epinephrine Firefighter 130

The Skeptics' Guide to EM

MARCH 11, 2023

Date: March 8, 2023 Reference: Smida et al. Date: March 8, 2023 Reference: Smida et al. A fire company is on scene providing high-quality cardiopulmonary resuscitation (CPR) and has defibrillated twice with an automated external defibrillator (AED). Reference: Smida et al.

CPR 130

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

Life Support 130

Life Support CPR Advanced Life Support Defibrillator 130

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.

Epinephrine 130

Epinephrine Life Support Advanced Life Support Defibrillator 130

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).

BLS 130

BLS Defibrillator Critical Care CPR 130

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.

EMR 130

EMR Coronary Defibrillator Life Support 130

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.

CPR 130

CPR Firefighter Paramedic Epinephrine 130

Paramedics Unlimited

APRIL 19, 2018

What is the difference between ALS and BLS Medical Care? In Advanced Life support (ALS) emergencies, a “single” paramedic or ER doctor can not deliver necessary care. And it becomes impossible to treat multi-system injuries, such as doing chest compression (CPR) while trying to open an airway or control bleeding.

BLS 52

BLS ALS Emergency Medical Technician Advanced Life Support 52

EMDocs

OCTOBER 25, 2024

3: Does Defibrillator Pad Placement Matter for OHCA? Source Initial Defibrillator Pad Position and Outcomes for Shockable Out-of-Hospital Cardiac Arrest. We always work hard, but we may not have time to read through a bunch of journals. It’s time to learn smarter. West J Emerg Med. 2024;25(5):680-689. #3: JAMA Netw Open. 2024.31673.

Defibrillator 88

Defibrillator Emergency Department ALS OR 88

The Skeptics' Guide to EM

JANUARY 9, 2021

Date: January 5th, 2021 Reference: Grunau et al. Date: January 5th, 2021 Reference: Grunau et al. Reference: Grunau et al. OHCA was defined as persons found apneic and without a pulse who underwent either external defibrillation (bystanders or EMS) or chest compressions.

EMS 130

EMS Emergency Medical Services CPR Critical Care 130

The Skeptics' Guide to EM

JULY 3, 2021

Reference: Dankiewicz et al: TTM2 Trial Investigators. Reference: Dankiewicz et al: TTM2 Trial Investigators. Paramedics managed to get return of spontaneous circulation after a single defibrillation, but the patient is still comatose on arrival. Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest.

Paramedic 130

Paramedic Defibrillator ALS OR 130

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.

Defibrillator 132

Defibrillator Coronary ALS STEMI 132

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.

CPR 130

CPR ICU Critical Care Epinephrine 130

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

Defibrillator 104

Defibrillator CPR Epinephrine Life Support 104

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.

CPR 100

CPR Defibrillator ALS Emergency Response 100

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.

Coronary 144

Coronary Defibrillator CPR ALS 144

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.

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

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. References Prinzmetal M, Kennamer R, Merliss R, et al. Myerburg RJ, Kessler KM, Mallon SM et al. Magid DJ, Aziz K, Cheng A, et al. Click to enlarge.)

Coronary 98

Coronary Life Support ALS Emergency Department 98

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

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

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.

E-9-1-1 102

E-9-1-1 EMS ALS Defibrillator 102

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.

Defibrillator 91

Defibrillator OR ED ALS 91

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-9-1-1 114

E-9-1-1 ALS Defibrillator OR 114

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 82

Defibrillator ALS Coronary OR 82

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.,

Defibrillator 52

Defibrillator ALS OR 52

EM Didactic

NOVEMBER 19, 2018

ERC 2015 guidelines recommend withholding adrenaline administration in hypothermic CA (HT IV) and limiting defibrillation to three attempts until the core temperature is >30 °C. ECLS has substantially improved survival and is the treatment of choice in the patient with unstable circulation or CA. Many arrhythmias (e.g.

CPR 52

CPR Defibrillator ALS OR 52

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.

E-9-1-1 52

E-9-1-1 Defibrillator ICU Critical Care 52

Don't Forget the Bubbles

JULY 26, 2023

Stredder et al, Archives of Disease in Childhood 2016 we see that 58% were not asked about triggers, 30% were not asked about duration and, importantly for risk stratification, 59% were not asked for a family history of cardiac disease. Palpitations (or descriptions thereof) are common but true arrhythmias are not.

ALS 98

ALS ED OR CPR 98

Dr. Smith's ECG Blog

JANUARY 23, 2024

She was given CRT-D (Cardiac Resynchronization Therapy-Defibrillator). For the majority of the tracing there are two P waves for each QRS. There is a LBBB. The PR interval gradually prolongs until a QRS is dropped and the pattern repeats itself. If there is no BBB the QRS will be narrow. There is for the most part 2:1 AV block.

Coronary 108

Coronary OR Defibrillator ALS 108

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

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.,

E-9-1-1 52

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

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.

CPR 52

CPR Defibrillator EMS Epinephrine 52