Dr. Smith's ECG Blog

JULY 25, 2024

He was defibrillated into VT. He then underwent dual sequential defibrillation into asystole. See these related cases: Cardiac arrest, defibrillated, diffuse ST depression and ST Elevation in aVR. This patient was witnessed by bystanders to collapse. They started CPR. EMS arrived and found him in Ventricular Fibrillation (VF).

Defibrillator 124

Defibrillator Coronary Epinephrine ACS 124

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 131

Defibrillator Coronary ALS STEMI 131

Dr. Smith's ECG Blog

APRIL 24, 2015

Again, it is common to have an ECG that shows apparent subendocardial ischemia after resuscitation from cardiac arrest, after defibrillation, and after cardioversion. Much depends on the post resuscitation ECG and its evolution shortly after defibrillation. Does this patient have ACS? Should he necessarily go to the cath lab?

Defibrillator 52

Defibrillator ACS CAD STEMI 52

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

APRIL 2, 2024

He was defibrillated, but they also noticed that he was being internally defibrillated and then found that he had an implantable ICD. He was unidentified and there were no records available After 7 shocks, he was successfully defibrillated and brought to the ED. There was no bystander CPR.

Defibrillator 133

Defibrillator Coronary Epinephrine CPR 133

Dr. Smith's ECG Blog

MAY 19, 2020

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.

Defibrillator 52

Defibrillator CPR Coronary CAD 52

Dr. Smith's ECG Blog

JUNE 9, 2024

We also gave insulin and furosemide (which take much longer to have their effect) After episodes of asystole and VF with defibrillation, she obtained ROSC and this 12-lead was recorded: The monitor around this time was NOT showing a very wide complex What do you think? How would you treat?

Defibrillator 101

Defibrillator Epinephrine OR 101

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

VF was refractory to amiodarone, lidocaine, double-sequential defibrillation, esmolol, etc. Then the patient would have been taken to the critical care area with a defibrillator at his side while waiting for the cath lab to be ready. Resuscitative attempts were initiated quickly. Eventually asystole, and the patient died.

Defibrillator 135

Defibrillator Coronary STEMI CPR 135

REBEL EM

JUNE 1, 2023

Known cardiac defibrillator. appeared first on REBEL EM - Emergency Medicine Blog. Indication for emergency invasive coronary angiography or had coronary angiography within 1 hour of arrival. Known obstructive coronary artery disease or known coronary stent. Pre-existing DNR order. Severe renal dysfunction.

Coronary 145

Coronary Defibrillator CPR ALS 145

Dr. Smith's ECG Blog

OCTOBER 23, 2023

She was successfully revived after several rounds of ACLS including defibrillation and amiodarone. In our hope of increasing appreciation of the clinical insights that this fascinating phenomenon may provide — we highlight its occurrence in our blog posts. On arrival to the ED the patient was intubated with normal vital signs.

ICU 131

ICU OR Defibrillator EMS 131

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 ). Like most clinicians — I learned about artifact "the hard way" = by seeing clinical cases that initially fooled me.

Defibrillator 81

Defibrillator ALS Coronary OR 81

Dr. Smith's ECG Blog

JUNE 13, 2024

She was successfully defibrillated and taken back to the ED. They also sued both EMTs for allegedly not starting chest compressions and defibrillating quickly enough. The physician documented that she was “improved” and the patient was discharged. The following morning, the patient collapsed in the kitchen in front of her family.

Defibrillator 92

Defibrillator STEMI EMT EMT 92

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

This episode self terminated before defibrillation was possible. For review of how Systematic 12-Lead ECG Interpretation not only increases accuracy, but also speeds you up — Please check out ECG Podcast #1 , wit h outline and link to my talk on this subject in the July 24, 2024 post in Dr. Smith's ECG Blog.

E-9-1-1 113

E-9-1-1 ALS Defibrillator OR 113

Dr. Smith's ECG Blog

SEPTEMBER 29, 2024

Today's case reminds us of the intuitive logic that if a patient has a shockable arrest ( ie, VFib ) — and following successful defibrillation shows evidence of acute OMI ( even if STEMI criteria are not necessarily fulfilled ) — that such patients have much to gain from immediate cath with PCI. (

STEMI 110

STEMI Coronary Defibrillator OR 110

EMDocs

FEBRUARY 9, 2024

Adapted from Dr. Smith’s EKG Blog. Defibrillator pads are placed and you give 2 g IV magnesium over ten minutes. It is recommended to use an unsynchronized setting as the defibrillator may not be able to track the R-wave in the polymorphic waveform. An ECG is performed and is shown below: Figure 1. She denies chest pain.

Defibrillator 96

Defibrillator OR ED ALS 96

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". The LCX was noted to be "subtotally stenosed" at the time of cath.

STEMI 98

STEMI Coronary Defibrillator EMS 98

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The arrhythmia spontaneously converted before defibrillation was achieved. Just prior to arrival he fell out of consciousness with the below ECG on the monitor. ECG #3 The above ECG shows a polymorphic VT at a rate of about 180 BPM.

Coronary 128

Coronary ACS Emergency Department Defibrillator 128

Dr. Smith's ECG Blog

OCTOBER 18, 2023

She spontaneously converted (Defibrillation was not performed). Most such rhythms in the setting of ischemia are VF and will not convert without defibrillation. The patient was given chest compressions while waiting for the cardiac arrest team to arrive. After about 90 seconds of chest compressions she awoke.

Defibrillator 122

Defibrillator Advanced Life Support Coronary Life Support 122

Dr. Smith's ECG Blog

SEPTEMBER 12, 2023

Figure-2: A rapid method for estimating the QTc ( Figure from My Comment in the March 19, 2019 post in Dr. Smith's ECG Blog ). == Clinical Implications of a Short QTc: The differential diagnosis for today's tracing, with its short QTc ~360 msec. Treatment is by ICD ( implantable cardioverter defibrillator ).

Defibrillator 69

Defibrillator OR 69

Dr. Smith's ECG Blog

JANUARY 23, 2024

She was given CRT-D (Cardiac Resynchronization Therapy-Defibrillator). Learning points: == MY Comment , by K EN G RAUER, MD ( 1/15 /2024 ): == Today's case by Dr. Nossen differs from other cases of AV block we have published over the years in Dr. Smith's ECG Blog — in that the cause of AV block turned out to be CS ( C ardiac S arcoidosis ).

Coronary 107

Coronary OR Defibrillator ALS 107

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. Of note — the QT interval of beat #5 ( blue line ) is markedly prolonged compared to the QT interval in the beginning of the tracing ( red line ). What does this ECG tell you?

Defibrillator 68

Defibrillator Coronary OR ALS 68

Dr. Smith's ECG Blog

SEPTEMBER 27, 2023

After amiodarone and several defibrillations and about 20 minutes after initial arrest, stable ROSC was achieved. How did the PM Cardio Queen of Hearts perform: Not OMI with low confidence. ECG#3 Resuscitation efforts were ongoing. ROSC was achieved shortly before new episodes of ventricular tachycardia.

Defibrillator 133

Defibrillator OR Coronary EMS 133

Dr. Smith's ECG Blog

OCTOBER 21, 2022

As worrisome as the initial recording in leads I and II look — a glance at lead III should immediately reassure us that defibrillation is not needed! I thoroughly reviewed this concept ( as well as other helpful clues to the presence of artifact ) in My Comment — at the bottom of the page in the August 26, 2022 post in Dr. Smith’s ECG Blog.

Defibrillator 52

Defibrillator ED OR 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. There is No Association with Improved Outcomes for Head Up CPR: Why We Must Read Past the Abstract appeared first on REBEL EM - Emergency Medicine Blog.

CPR 52

CPR Defibrillator EMS Epinephrine 52

Dr. Smith's ECG Blog

APRIL 6, 2018

EMS report was that the patient had unknown down time with unwitnessed arrest, found initially in VFib arrest, defibrillated x1 followed by PEA arrest alternating with asystolic arrest during transport. Upon closer inspection, the defibrillator's monitor had assigned a spike for every large T wave as well as every QRS complex.

Defibrillator 52

Defibrillator ICU EMS Plasma 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

ECG 2 Especially in the context of the first ECG, readers of this blog will readily appreciate the ST elevations and hyperacute T waves in II, III, aVF, V6, and to a lesser extent V5. As discussed on this blog many times before, proportionality is key to the diagnosis of OMI by ECG. [link] I also texted the ECG to Dr. Smith.

Critical Care 64

Critical Care Defibrillator OR ALS 64

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. References : 1.

Defibrillator 52

Defibrillator ACS CPR STEMI 52

Dr. Smith's ECG Blog

JULY 14, 2010

She was defibrillated successfully from ventricular fibrillation and developed a perfusing rhythm. A 56 yo f with h/o HTN and hypercholesterolemia called EMS from home after onset of L chest pain radiating to the left arm. Before EMS arrived, she had "seizure activity" and became unresponsive. She was intubated.

Defibrillator 52

Defibrillator OR EMS 52

Dr. Smith's ECG Blog

FEBRUARY 25, 2009

The patient had 2 ventricular fibrillation arrests during transport, but was immediately defibrillated both times, and was awake in the ED, when the following ECG was recorded: The ST elevation has mostly resolved on this ECG, and were it not for the arrest and the prehospital ECG, this would not be a slam dunk diagnosis.

Defibrillator 52

Defibrillator STEMI Paramedic EMS 52

Dr. Smith's ECG Blog

OCTOBER 4, 2010

He was resuscitated with chest compressions and defibrillation and 1 mg of epinephrine. This young male had ventricular fibrillation during a triathlon. On his bib it stated that he had a congenital heart disorder. He arrived in the emergency department hemodynamically stable. His initial ECG is shown here.

ACS 52

ACS Defibrillator Epinephrine STEMI 52

Dr. Smith's ECG Blog

SEPTEMBER 21, 2020

He was found in ventricular fibrillation and defibrillated, then brought to a local ED which does not have a cath lab. This blog is full of cases in which OMI that did not meet STEMI millimeter criteria were dismissed. Smith’s ECG Blog ). Here is the initial ED ECG: This is pretty obviously and inferior posterior OMI, right?

STEMI 52

STEMI Defibrillator ED ACS 52

First Responders Foundation

JULY 31, 2024

This blog post explores how your donations can significantly impact first responders, enhancing their capabilities and ensuring they can continue to perform their duties effectively and safely. For instance, donations can fund thermal imaging cameras that allow firefighters to see through smoke and locate individuals in burning buildings.

First Responder 52

First Responder Public Safety Mental Health Services Firefighter 52

Dr. Smith's ECG Blog

AUGUST 17, 2019

But after reading this blog, you all know that most OMI do NOT meet STEMI criteria. Defibrillated out of v fib in the cath lab. I thank you for constantly updating your blog and allowing free open access education on EKG interpretation. mm in men over age 40. So there is definitely no STEMI, and the STE is normal.

STEMI 52

STEMI Defibrillator ED OR 52

Dr. Smith's ECG Blog

OCTOBER 3, 2017

This is another case written by Pendell Meyers (who is helping to edit the blog and has many great recent posts) Case A 45 year old man was driving to work when he experienced acute onset sharp left sided chest pain with paresthesias of the left arm. He received aspirin en route via EMS, and no EMS ECGs are available.

CPR 52

CPR Defibrillator STEMI ED 52

Dr. Smith's ECG Blog

DECEMBER 23, 2014

He was defibrillated. The formula results in 23.43, just above the 23.4 The patient was diagnosed with esophageal reflux and was being discharged by the nurse when he had a cardiac arrest. Here is his post resuscitation ECG: Now the diagnosis is obvious. Anterolateral STEMI.

Defibrillator 52

Defibrillator STEMI Coronary 52

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

But because Dr. Mastoras recognized the hyperacute T waves, the patient was immediately seen, the polymorphic VT was immediately defibrillated, and the patient was rapidly diagnosed and treated. For more on this topic — See discussion in the October 24, 2019 and July 31, 2018 posts in Dr. Smith's ECG Blog ).

OR 66

OR STEMI ACS Coronary 66

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. On arrival, CPR was continued and core temperature was measured at 18° C (64.4° A 12-lead ECG was recorded: There is sinus rhythm with RBBB and right axis deviation.

CPR 40

CPR Defibrillator Life Support ED 40