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. As part of their protocol, they attempt vascular access to administer epinephrine and an antidysrhythmic. Case: A 46-year-old man has a cardiac arrest at home, witnessed by family.

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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. 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.

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Defibrillator Coronary Epinephrine ACS 126

The Skeptics' Guide to EM

MARCH 2, 2019

It required multiple attempts which caused several prolonged interruptions in CPR. Key to survival is high-quality CPR and early defibrillation. After the patient is stabilized the medic asks you how he can improve his airway management skills during a cardiac arrest as it was difficult to intubate during compressions.

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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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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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EMDocs

JANUARY 8, 2024

Vasopressor medications during cardiac arrest We recommend that epinephrine be administered for patients in cardiac arrest. It is reasonable to administer epinephrine 1 mg every 3 to 5 minutes for cardiac arrest. High-dose epinephrine is not recommended for routine use in cardiac arrest. COR 1, LOE B-R. COR 2a, LOE B-R.

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Epinephrine Defibrillator Coronary CPR 98

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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ECG Medical Training

DECEMBER 4, 2016

Cardiac Care Show – Episode #1: Mechanical CPR Hello, and welcome to the Cardiac Care Show. In today’s episode I’d like to talk about mechanical CPR, which is a frequent topic of conversation in the Resuscitation group on Facebook and the #FOAMed community on Twitter. So, mechanical CPR is a no-brainer, right?

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EMDocs

JANUARY 16, 2024

The patient received 1 mg of epinephrine IV x2 with conversion of his rhythm to ventricular fibrillation (VF) for which he was defibrillated twice in the field. The patient is moved over to the stretcher and connected to the monitors and defibrillator. What would your next steps be?

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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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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

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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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. at the time of the ECG. References : 1.

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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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Dr. Smith's ECG Blog

APRIL 29, 2020

CPR was started immediately. 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. Is this inferior MI?

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Dr. Smith's ECG Blog

OCTOBER 20, 2013

Medics found her apneic and pulseless, began CPR, and she was found to be in asystole. 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. BP gradually rose.

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STEMI Coronary ACS Emergency Department 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

CPR was initiated immediately. It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation. After approximately 1 hour of total intermittent CPR time, final ROSC achieved.Patient did have extremity movement during central line placement. On epinephrine and norepinephrine drips."

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ACS CPR CAD Heart Attack 52

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.

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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? 7 In attempts to improve survival of this devastating condition, investigators have reported alternative defibrillation techniques.

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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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FOAMfrat

NOVEMBER 25, 2024

In the standard care of anaphylactoid reactions, we administer Epinephrine, Diphenhydramine, steroids, and bronchodilators. Sure, we still do CPR, defibrillate as needed, and give Epinephrine based upon our local guidance. Could this work for the AFE patient? The American Academy of Obstetrics and Gynecology isn’t sure.

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