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

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. He reports feeling nauseated with emesis. There is ischemic ST depression in V4-V6.

Defibrillator 131

Defibrillator Coronary STEMI CPR 131

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?

Defibrillator 103

Defibrillator Epinephrine OR 103

REBEL EM

JUNE 1, 2023

Known cardiac defibrillator. appeared first on REBEL EM - Emergency Medicine Blog. Design: Prospective, observational, before and after implementation of a protocol study. Excluded: Obvious cause for OHCA prior to SDCT or on hospital arrival. Known obstructive coronary artery disease or known coronary stent. Pre-existing DNR order.

Coronary 145

Coronary Defibrillator CPR ALS 145

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 85

E-9-1-1 Defibrillator CPR STEMI 85

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. A healthy 45-year-old female presented with chest pain, with normal vitals. What do you think? There’s TWI in aVL but this is concordant to its QRS.

OR 70

OR STEMI ACS Coronary 70

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 120

ICU OR Defibrillator EMS 120

Dr. Smith's ECG Blog

JANUARY 2, 2025

T-waves are quite tall and possibly peaked (HyperK?), but potassium returned normal. I do not see OMI here and all trops were only minimally elevated, consistent with either chronic injury from cardiomyopathy or with acute injury from sepsis. What is the QT interval? In LBBB, the QT interval is partly prolonged by the wide QRS. Bogossian et al. (1)

Coronary 86

Coronary OR Defibrillator ALS 86

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-9-1-1 107

E-9-1-1 ALS Defibrillator OR 107

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 ). The red coloring is because the telemetry software incorrectly identified the artifact as VT. See if you can identify the underlying QRS complexes. Here is an example of that.

Defibrillator 76

Defibrillator ALS Coronary OR 76

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". In this case, the EMS provider was routed to the urgent care facility.

STEMI 95

STEMI Coronary Defibrillator EMS 95

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The arrhythmia spontaneously converted before defibrillation was achieved. When you have identified the end of the QRS complex and the beginning of the ST segment you can assess whether there is concordant ST segment elevation, concordant ST depression or whether there are excessively discordant ST segments.

Coronary 127

Coronary ACS Emergency Department Defibrillator 127

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.

OR 52

OR Defibrillator EMS 52

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 93

STEMI Coronary Defibrillator OR 93

Dr. Smith's ECG Blog

SEPTEMBER 27, 2023

After amiodarone and several defibrillations and about 20 minutes after initial arrest, stable ROSC was achieved. ECG#1 There is a regular tachycardia with a ventricular rate of about 180 bpm. Smith comment : When there is a regular wide complex tachycardia, first assess whether it is sinus or not. At a rate of 180, this is unlikely.

Defibrillator 128

Defibrillator OR Coronary EMS 128

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 72

Defibrillator OR ED ALS 72

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 above ECGs show the initiation and continuation of a polymorphic ventricular tachycardia. After about 90 seconds of chest compressions she awoke.

Defibrillator 105

Defibrillator Advanced Life Support Coronary Life Support 105

FOAMfrat

DECEMBER 31, 2024

Essentially, to put this blog to rest You will treat the patient the same as any other patient. With that being said, the manufacturers say that CPR, medications, Defibrillation, Cardioversion, and Anything you would normally do are OKAY. We still defibrillate ventricular fibrillation just as we would any other patient.

CPR 64

CPR Defibrillator Emergency Department Emergency Transportation 64

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 ). 1 for a rate ~75/min; 1.

Defibrillator 72

Defibrillator OR 72

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. They had difficulty describing their symptoms, but complained of severe weakness, nausea, vomiting, headache, and chest pain. His response was: "OMI.

Critical Care 67

Critical Care Defibrillator OR ALS 67

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.

Defibrillator 71

Defibrillator Coronary OR ALS 71

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 86

Coronary OR Defibrillator ALS 86

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

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

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 OR ED 52

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. It was stented.

Defibrillator 52

Defibrillator ACS CPR STEMI 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

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. Here is the initial ED ECG: This is pretty obviously and inferior posterior OMI, right?

STEMI 52

STEMI Defibrillator ED ACS 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. This was the Marquette 12 SL GE algorithm The computer did not even mention the ST elevation.

STEMI 52

STEMI Defibrillator ED OR 52

Dr. Smith's ECG Blog

DECEMBER 20, 2024

This is the shock coil and identifies this device as a defibrillator. CRT-D is cardiac resynchronization therapy with defibrillation capability, like the CXR above. CRT-P is cardiac resynchronization therapy with pacing only, without the ability to defibrillate. Specifically, it overlies a thicker radiopaque segment.

Defibrillator 75

Defibrillator Coronary ALS Emergency Department 75

Dr. Smith's ECG Blog

APRIL 29, 2020

She was never defibrillated. As was seen in this case — defibrillation and/or overdrive pacing may be needed. She was given 3 mg IV epinephrine and multiple rounds of ACLS over approximately 20 minutes. Her husband stated that she had not been feeling well in the past 2 weeks and c/o dizziness as well as diarrhea. What do you think?

Defibrillator 52

Defibrillator Epinephrine Coronary Overdose 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

Schick is a PGY3 at the Brown Emergency Medicine Residency in Rhode Island. I remember Allie well from her days in the Research volunteer program at Hennepin. The article is edited by Smith. Title: Is it just hot in here or is it a OMI? See additional image at the bottom of this post. Could this be induced by elevated core temperature? F (rectal).

E-9-1-1 52

E-9-1-1 CAD STEMI OR 52

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

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.

ALS 52

ALS OR Defibrillator ED 52

Dr. Smith's ECG Blog

JUNE 19, 2023

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. mm STE in III, and possibly 0.5

STEMI 52

STEMI ACS Coronary Defibrillator 52