Blog, Defibrillator and Epinephrine

SGEM#426: All the Small Things – Small Bag Ventilation Masks in Out of Hospital Cardiac Arrest

The Skeptics' Guide to EM

JANUARY 13, 2024

You continue with compressions and defibrillations and your partner places an advanced airway. The patient is a 54-year-old man who collapsed in front of his family after complaining of chest pain for several hours. On your arrival, first responders from the fire department are performing high-quality basic cardiac life support.

CPR

CPR Defibrillator First Responder Epinephrine

Transcutaneous Pacing: Part I

EMS 12-Lead

MARCH 30, 2024

Josh Kimbrell, NRP @joshkimbre Judah Kreinbrook, EMT-P @JMedic2JDoc This is the first installment of a blog series showing how transcutaneous pacing (TCP) can be difficult, and how you can improve your skills. After administering 1mg of epinephrine ROSC is noted with a bradycardic rhythm ( Figure 2 ).

CPR

CPR Paramedic Ambulance Defibrillator

Resuscitated from ventricular fibrillation. Should the cath lab be activated?

Dr. Smith's ECG Blog

JULY 25, 2024

He was defibrillated into VT. He then underwent dual sequential defibrillation into asystole. After 1 mg of epinephrine they achieved ROSC. Total prehospital meds were epinephrine 1 mg x 3, amiodarone 300 mg and 100 mL of 8.4% This patient was witnessed by bystanders to collapse. They started CPR. sodium bicarbonate.

Defibrillator

Defibrillator Coronary Epinephrine ACS

REBEL Cast Ep113: Defibrillation Strategies for Refractory Ventricular Fibrillation

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.

Defibrillator

Defibrillator Paramedic CPR EMS

Prehospital "Altered mental status and hypotension due to probable DKA" (everyone must know this ECG diagnosis)

Dr. Smith's ECG Blog

JUNE 9, 2024

Over the next 10 minutes we resuscitated with high doses of Calcium, Epinephrine, and Bicarbonate. There was no IV access, so we obtained intraosseous (IO) access, but she arrested before we could give her all the calcium. Weakness, prolonged PR interval, wide complex, ventricular tachycardia Very Wide and Very Fast, What is it?

Defibrillator

Defibrillator Epinephrine OR

Ventricular Fibrillation, ICD, LBBB, QRS of 210 ms, Positive Smith Modified Sgarbossa Criteria, and Pacemaker-Mediated Tachycardia

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

Defibrillator Coronary Epinephrine CPR

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

Dr. Smith's ECG Blog

JULY 21, 2024

Epinephrine infusion was begun. 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. An ICD ( Implantable Cardioverter Defibrilator ) was placed prior to discharge. What do you think?

Defibrillator

Defibrillator Coronary ALS STEMI

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The arrhythmia spontaneously converted before defibrillation was achieved. The patient was administered thrombolytics and shortly after the lytics were administered, the systolic blood pressure rose to about 80mmHg with ongoing epinephrine infusion. Just prior to arrival he fell out of consciousness with the below ECG on the monitor.

Coronary

Coronary ACS Emergency Department Defibrillator

Cardiac Arrest, acute ST elevation and depression superimposed on LVH, but NOT due to ACS

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

ACS Defibrillator Epinephrine STEMI

Heads Up! There is No Association with Improved Outcomes for Head Up CPR: Why We Must Read Past the Abstract

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

CPR Defibrillator EMS Epinephrine

Cardiac arrest: even after the angiogram, the diagnosis is not always clear

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. Fine ventricular fibrillation She received 2 mg epinephrine, 150 mg amiodarone and underwent chest compressions with the LUCAS device. at the time of the ECG. References : 1.

Defibrillator

Defibrillator ACS CPR STEMI

A middle aged man with unwitnessed cardiac arrest

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. Chest compressions were continued, and the patient was given 1 round of epinephrine, calcium, bicarb, glucose.

Defibrillator

Defibrillator ICU EMS Plasma

Cardiac Arrest. What does the ECG show? Also see the bizarre Bigeminy.

Dr. Smith's ECG Blog

APRIL 29, 2020

She was given 3 mg IV epinephrine and multiple rounds of ACLS over approximately 20 minutes. She was never defibrillated. This is commonly found after epinephrine for cardiac arrest, but could have been pre-existing and a possible contributing factor to cardiac arrest. EMS arrived and found her in a wide complex PEA rhythm.

Defibrillator

Defibrillator Epinephrine Coronary Overdose

A man with chest pain off and on for two days, and "No STEMI" at triage.

Dr. Smith's ECG Blog

JUNE 19, 2023

The patient is started on epinephrine infusion for cardiogenic shock and cardiology took the patient to the cath lab. During angiogram in the cath lab, the patient suffered two episodes of ventricular fibrillation for which he was successfully defibrillated.

STEMI

STEMI ACS Coronary Defibrillator

Middle Aged Woman with Asystolic Cardiac Arrest, Resuscitated: Cath Lab?

Dr. Smith's ECG Blog

OCTOBER 20, 2013

With ventilations and epinephrine, she regained a pulse. She was never seen to be in ventricular fibrillation and was never defibrillated. A middle-age woman with h/o hypertension was found down by her husband. Medics found her apneic and pulseless, began CPR, and she was found to be in asystole. BP gradually rose.

STEMI

STEMI Coronary ACS Emergency Department

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

OCTOBER 10, 2022

It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation. On epinephrine and norepinephrine drips." NOTE: For more on the ECG diagnosis of acute RV "strain" ( and acute PE ) — Please check out My Comment at the bottom of the page in the March 28, 2022 post in Dr. Smith's ECG Blog.

ACS

ACS CPR CAD Heart Attack

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

Dr. Smith's ECG Blog

APRIL 8, 2016

At cath, he immediately had incessant Torsades de Pointes requiring defibrillation 7 times and requiring placement of a transvenous pacer for overdrive pacing at a rate of 80. The patient was intubated, given antiplatelet and antithrombotic therapy, 10 mEq of KCl IV was started, and sent to the cath lab.

STEMI

STEMI Plasma Defibrillator OR

Cardiac Arrest, hypotension, tachycardia

Dr. Smith's ECG Blog

DECEMBER 22, 2010

After epinephrine, atropine, and defibrillation x 2, there was a return of pulses. 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. Exact rhythm during arrest is uncertain.

STEMI

STEMI Defibrillator Epinephrine Emergency Department

Trifecta: Amniotic Fluid Embolism

FOAMfrat

NOVEMBER 25, 2024

Earlier in the summer, I wrote a blog discussing the challenges, intricacies, and educational pitfalls of postpartum hemorrhage in EMS. In the standard care of anaphylactoid reactions, we administer Epinephrine, Diphenhydramine, steroids, and bronchodilators. I even know of cases that my colleagues have managed!

Epinephrine

Epinephrine CPR Operating Room Plasma

Acute coma, then Sudden PEA arrest in front of paramedics, with STEMI?

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

Resuscitated with chest compressions, epinephrine. including epinephrine, and there was ROSC. This is what the providers in the ED understood on patient arrival: Patient called 911 for syncope, then had witnessed PEA arrest after medics arrived. Not a shockable rhythm. They laid her on the floor and called 911.

STEMI

STEMI Paramedic E-9-1-1 Epinephrine

Paramedicine Now

SGEM#426: All the Small Things – Small Bag Ventilation Masks in Out of Hospital Cardiac Arrest

Transcutaneous Pacing: Part I

Trending Sources

Resuscitated from ventricular fibrillation. Should the cath lab be activated?

REBEL Cast Ep113: Defibrillation Strategies for Refractory Ventricular Fibrillation

Prehospital "Altered mental status and hypotension due to probable DKA" (everyone must know this ECG diagnosis)

Ventricular Fibrillation, ICD, LBBB, QRS of 210 ms, Positive Smith Modified Sgarbossa Criteria, and Pacemaker-Mediated Tachycardia

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

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

Cardiac Arrest, acute ST elevation and depression superimposed on LVH, but NOT due to ACS

Heads Up! There is No Association with Improved Outcomes for Head Up CPR: Why We Must Read Past the Abstract

Cardiac arrest: even after the angiogram, the diagnosis is not always clear

A middle aged man with unwitnessed cardiac arrest

Cardiac Arrest. What does the ECG show? Also see the bizarre Bigeminy.

A man with chest pain off and on for two days, and "No STEMI" at triage.

Middle Aged Woman with Asystolic Cardiac Arrest, Resuscitated: Cath Lab?

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

Cardiac Arrest, hypotension, tachycardia

Trifecta: Amniotic Fluid Embolism

Acute coma, then Sudden PEA arrest in front of paramedics, with STEMI?

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