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

Dr. Smith's ECG Blog

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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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). 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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REBEL Cast Ep113: Defibrillation Strategies for Refractory Ventricular Fibrillation

REBEL EM

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

Dr. Smith's ECG Blog

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. Or 2) The ischemia of an ECG post-arrest?

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

Dr. Smith's ECG Blog

CPR was started immediately. She was never defibrillated. The ultimate reason for the long QT was never definitively determined. Drug-induced QT interval cannot be completely ruled out, but the tox consult found the she had definitely not overdosed and did not believe that therapeutic doses would do this.

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SGEM#247: Supraglottic Airways Gonna Save You for an OHCA?

The Skeptics' Guide to EM

They had a difficult time getting a definitive airway pre-hospital. It required multiple attempts which caused several prolonged interruptions in CPR. Key to survival is high-quality CPR and early defibrillation. Case: EMS arrive to your emergency department with a 68-year-old man post cardiac arrest patient.

CPR 130
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A 50-something with chest pain.

Dr. Smith's ECG Blog

VF was refractory to amiodarone, lidocaine, double-sequential defibrillation, esmolol, etc. Suppose the OMI had been recognized, or suppose another ECG had been recorded and it showed definite OMI. But as it was, the delay to defibrillation was not long and it may be that nothing could have saved him.