Emergency Medicine Cases

JANUARY 29, 2019

In this CritCases blog Michael Misch takes us through a case of accidental hypothermia and cardiac arrest, reviewing the controversies in management as well as the guidelines for rewarming, the role of ECMO and the alterations to ACLS cardiac arrest medications, CPR and defibrillations.

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Defibrillator CPR EMS 130

Dr. Smith's ECG Blog

JULY 9, 2024

His family started CPR and called EMS, who arrived to find him in ventricular fibrillation. 15 minutes after EMS arrival, after at least 6 defibrillations, the patient achieved sustained ROSC. Written by Pendell Meyers A man in his 50s was found by his family in cardiac arrest of unknown duration. Further information is not available.

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Defibrillator STEMI CPR EMS 115

The Skeptics' Guide to EM

SEPTEMBER 23, 2017

Case: You are the medical director of an EMS system in a large city deciding on whether to respond to all out of hospital cardiac arrests (OHCA) with ACLS capabilities, or if resources should be directed to those candidates for extracorporeal CPR. Bystander high-quality CPR can buy you some time until defibrillation.

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Life Support CPR Advanced Life Support Defibrillator 130

ESO

DECEMBER 18, 2024

After reviewing over 12 million EMS incidents that took place in 2023 , the 2024 ESO EMS Index highlights two critical areas that demand attention: Early CPR and Opioid Use Disorder (OUD). The importance of early CPR The earlier CPR is performed, the better the outcome. Gender disparities were also found. Want to learn more?

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CPR Naloxone Overdose Defibrillator 52

The Skeptics' Guide to EM

MARCH 11, 2023

A fire company is on scene providing high-quality cardiopulmonary resuscitation (CPR) and has defibrillated twice with an automated external defibrillator (AED). Background: Airway management strategies for out of hospital cardiac arrest (OHCA) have been hotly debated since the dawn of CPR.

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CPR Defibrillator BLS Paramedic 130

The Skeptics' Guide to EM

SEPTEMBER 29, 2018

Bystander CPR is initiated prior to EMS arrival. One defibrillation for ventricular fibrillation (VF) is provided but the patient remains in VF. We now know that an emphasis on the basics (high quality chest compressions and defibrillation) are the most important aspects of resuscitation.

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BLS Defibrillator Critical Care CPR 130

The Skeptics' Guide to EM

DECEMBER 7, 2018

You are the first provider on scene with Emergency Medical Services (EMS) and start high-quality Cardiopulmonary Resuscitation (CPR). A cardiac defibrillator is hooked up and the patient is in ventricular fibrillation. Case: A 51-year-old man experiences a cardiac arrest on the street. He is unsuccessfully shocked.

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Epinephrine Life Support Advanced Life Support Defibrillator 130

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.

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Defibrillator Paramedic CPR EMS 52

Handtevy

MARCH 13, 2024

A recent case has highlighted the extraordinary potential of a novel intervention: triple-sequential defibrillation. The Case Unfolds Despite 82 minutes of high-quality CPR and Advanced Cardiovascular Life Support (ACLS) management, standard and dual-sequential defibrillation failed to restore the patient’s heartbeat.

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Defibrillator CPR Life Support EMS 52

The Skeptics' Guide to EM

FEBRUARY 25, 2023

Your team begins high quality cardiopulmonary resuscitation (CPR). Apart from high-quality CPR and early defibrillation, many other interventions we try lack a strong evidence base. Sodium bicarbonate has historically been used during CPR with the goal of alkalizing blood pH and treating metabolic acidosis.

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CPR ICU Critical Care Defibrillator 130

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). ECMO Flow was achieved after approximately 1 hour of high quality CPR. After good ECMO flow was established, she was successfully defibrillated. The K was normal. Troponin I rose to 44.1

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Dr. Smith's ECG Blog

JULY 25, 2024

They started CPR. 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. After 1 mg of epinephrine they achieved ROSC.

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Defibrillator Coronary Epinephrine ACS 123

ACEP Now

NOVEMBER 7, 2023

Multiple attempts at defibrillation, epinephrine, and amiodarone have been unsuccessful. Problem What is the best defibrillation strategy to treat refractory ventricular fibrillation? 2,3 Multiple published studies have addressed treatment of ventricular fibrillation with defibrillation and medications such as amiodarone and lidocaine.

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Defibrillator E-9-1-1 ALS Epinephrine 52

The Skeptics' Guide to EM

JANUARY 9, 2021

CPR is currently in progress with a single shock having been delivered. This has included things like therapeutic hypothermia ( SGEM#54 , SGEM#82 , SGEM#183 and SGEM#275 ), supraglottic devices ( SGEM#247 ), crowd sourcing CPR ( SGEM#143 and SGEM#306 ), and epinephrine ( SGEM#238 ).

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EMS Emergency Medical Services CPR Critical Care 130

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. Head Up (HUP) CPR may be the next critical improvement. Head Up (HUP) CPR may be the next critical improvement. Resuscitation 2022; 179: 9-17.

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CPR Defibrillator EMS Epinephrine 52

Dr. Smith's ECG Blog

APRIL 2, 2024

There was no bystander CPR. 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. An elderly man collapsed.

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Defibrillator Coronary Epinephrine CPR 131

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

The paramedics achieve return of spontaneous circulation (ROSC) after CPR, advanced cardiac life support (ALCS), and Intubation. Defibrillation is the treatment of choice in these cases but does not often result in sustained ROSC ( Kudenchuk et al 2006). She has a history of hypertension and non-insulin dependent diabetes mellitus.

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EMR Coronary Defibrillator Life Support 130

EMDocs

JANUARY 8, 2024

With respect to timing, for cardiac arrest with a shockable rhythm, it may be reasonable to administer epinephrine after initial defibrillation attempts have failed. Consider administering epinephrine after defibrillation in those with shockable rhythms. For patients with OHCA, use of steroids during CPR is of uncertain benefit.

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Epinephrine Defibrillator Coronary CPR 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.

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E-9-1-1 Defibrillator CPR STEMI 98

EM Didactic

NOVEMBER 19, 2018

age, co-morbidities, trauma) (3) speed of cooling (4) environment (air, water, snow) (5) CA features (body temperature; whether hypoxia preceded arrest; delay before instituting CPR, and CPR quality) (6) rescue considerations (e.g. International guidance differ on drug administration. Many arrhythmias (e.g.

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CPR Defibrillator ALS OR 52

SSCOR

DECEMBER 21, 2023

The elderly woman had gone into cardiac arrest just minutes before you arrived, but immediate CPR and rapid defibrillation were rewarded with a weak return of pulses. The call is going smoothly. Your IV is flowing and the patient is intubated.

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Defibrillator CPR EMS 52

K.S. Chew

MAY 25, 2019

This is a potentially fatal mistake because for VF, the one intervention besides CPR that is proven to increase survival to hospital discharge is defibrillation (but not for PEA). AHA CPR Guideline 2015: In addition to high-quality CPR,

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Peter Canning

JANUARY 14, 2024

I recerted CPR, ACLS (Advanced Cardiac Life Support) and PALS (Pediatric Advanced Life Support) late in December. When you are doing CPR and running cardiac arrests on a regular basis, it seems unnecessary to sit through a 2 hour class on CPR and 4 hour classes on ACLS and PALS. The certs are good for two years. mg via syringe.*

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CPR Naloxone EMT EMT 52

The Overrun Podcast

MAY 23, 2024

The conversation covers topics such as compression-only CPR, the controversy surrounding head-up CPR, the use of band and piston-driven devices, and the potential of extracorporeal cardiopulmonary resuscitation (eCPR). The importance of good dispatch and patient selection is emphasized as key factors in improving outcomes.

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CPR BLS EMS Life Support 52

EMT First Aid

JANUARY 24, 2024

defibrillator is a lifesaving piece of medical equipment which delivers an electrical shock to a cardiac arrest victim. Currently less than 10% of these people experiencing cardiac arrests in the community surviveAEDs are used in addition to CPR to save the lives of those suffering cardiac arrest. What is an AED and how to use one.A

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Defibrillator CPR 40

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. After resuming CPR and administering an additional 400 mcg IV NTG, the patient achieved return of spontaneous circulation with sinus tachycardia. Click to enlarge.)

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Coronary Life Support ALS Emergency Department 98

Dr. Smith's ECG Blog

OCTOBER 28, 2013

It was witnessed, and CPR was performed by trained individuals. She was found to be in ventricular fibrillation and was defibrillated 8 times without a single, even transient, conversion out of fibrillation. She arrived in the ED 37 minutes after 911 was called, with continuing CPR. References : 1.

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Defibrillator ACS CPR STEMI 52

NCOAE

AUGUST 12, 2022

Here, we present them in alphabetical order: ABC – Airway, Breathing and Circulation – “This is the Golden Rule of emergency medical professionals” AED – Automated External Defibrillator – The device that delivers electric shock to the heart of patients experiencing sudden cardiac arrest A-EMT – Advanced EMT ALS – Advanced Life Support Anaphylaxis— (..)

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EMS EMT EMT Emergency Medical Technician 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. His family has been performing bystander, and report that he suddenly collapsed just a few minutes ago.

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

NCOAE

MARCH 8, 2021

covering prehospital medical providers — recognizes three levels of EMTs/paramedics: EMT: EMTs provide non-invasive life-support services, such as cardiopulmonary resuscitation (CPR), administering oxygen, performing automated external defibrillation, basic and advanced airway management, and administering authorized medications.

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EMT EMT Emergency Medical Technician AEMT 52

Dr. Smith's ECG Blog

OCTOBER 3, 2017

After the second defibrillation the patient had an organized rhythm: Bradycardic escape/agonal rhythm, with large ST deviations. This rhythm reportedly produced no palpable pulse, and CPR was continued. 30 seconds later, however, the patient began spontaneously moving and CPR was discontinued.

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CPR Defibrillator STEMI ED 52

First Responders Foundation

JULY 31, 2024

Similarly, funds can help purchase new defibrillators for paramedics, ensuring they have access to reliable equipment during critical life-saving moments. These programs might include open houses at fire stations, community CPR classes, or public safety demonstrations.

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First Responder Public Safety Mental Health Services Firefighter 52

EMT Training Station

FEBRUARY 11, 2024

If the victim is unresponsive, CPR is initiated immediately. We use portable electrocardiogram (ECG) machines to monitor heart rhythms and are equipped to administer life-saving interventions like defibrillation or medication administration to stabilize the heart rhythm.

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EMT EMT Emergency Medical Technician First Aid 98

Dr. Smith's ECG Blog

APRIL 29, 2020

CPR was started immediately. She was never defibrillated. As was seen in this case — defibrillation and/or overdrive pacing may be needed. A 60-something woman presented after a witnessed cardiac arrest. EMS arrived and found her in a wide complex PEA rhythm.

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Defibrillator Epinephrine Coronary Overdose 52

High Performance EMS

OCTOBER 11, 2024

October is Sudden Cardiac Arrest Awareness month, so High Performance EMS and PulsePoint are encouraging everyone to locate and register Automated External Defibrillators (AEDs). It’s relatively recent that providing CPR instructions to callers (t-CPR) was considered best practice.

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Public Safety Defibrillator EMD CPR 317

Dr. Smith's ECG Blog

OCTOBER 26, 2020

12 minutes later, the patient went back into VFib arrest and underwent another 15 minutes of resuscitation followed by successful defibrillation and sustained ROSC. In total, he received approximately 40 minutes of CPR and 7 defibrillation attempts.

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Coronary Defibrillator ACS CAD 40

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

We could not resuscitate her, but we did have excellent perfusion with LUCAS CPR, such that pulse oximetry had excellent waveform and 100% saturations, end tidal CO2 was 35, and cerebral perfusion monitoring was near normal throughout the attempted resuscitation. How would you treat?

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Plasma STEMI Defibrillator Overdose 40