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Updates in the Management of Refractory Ventricular Tachycardia or Ventricular Fibrillation Arrest

ACEP Now

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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Journal Feed Weekly Wrap-Up

EMDocs

1: Hypertensive Crisis Averted…New AHA Statement on Asymptomatic Hypertension Spoon Feed This article emphasizes the difference between hypertensive emergency and asymptomatic elevated blood pressure (BP); while hypertensive emergency requires prompt treatment to lower BP, treatment of asymptomatic elevated BP in acute care settings may be harmful.

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1 hour of CPR, then ECMO circulation, then successful defibrillation.

Dr. Smith's ECG Blog

She was unable to be defibrillated but was cannulated and placed on ECMO in our Emergency Department (ECLS - extracorporeal life support). After good ECMO flow was established, she was successfully defibrillated. Here is a case of ECMO defibrillation with near shark fin that was due to proximal LAD occlusion. The K was normal.

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A Cardiac Arrest Story: Patient Interview

FOAMcast

This story is a reminder of the importance of continuous chest compressions, early defibrillation, and that what we do in emergency and prehospital medicine matters. Apple Podcasts , Spotify , or Listen Here This episode is a departure from the typical FOAMcast clinical content, we will be back with strictly clinical content soon.

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What are treatment options for this rhythm, when all else fails?

Dr. Smith's ECG Blog

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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A 40-something presented after attempted prehospital resuscitation with persistent Ventricular Fibrillation

Dr. Smith's ECG Blog

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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First10EM Journal Club: October 2022

Broome Docs

PMID: 35490863 Hands on defibrillation: Even if it’s safe, would it actually help? Ex vivo evaluation of personal protective equipment in hands-on defibrillation. PMID: 35942482 earing gloves, hands on defibrillation is probably safe. 2018 Sep 11;362:k3843. doi: 10.1136/bmj.k3843. N Engl J Med. doi: 10.1056/NEJMoa2202884.

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