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You continue with compressions and defibrillations and your partner places an advanced airway. SGEM#143: Call Me Maybe for Bystander CPR * SGEM#152: Movin’ on Up – Higher Floors, Lower Survival for OHCA * SGEM#162: Not Stayin’ Alive More Often with Amiodarone or Lidocaine in OHCA * SGEM#189: Bring Me to Life in OHCA *
The post Ep 169 Cardiac Arrest Controversies – Chest Compressions, Dual Defibrillation, Medications and Airway appeared first on Emergency Medicine Cases.
The paramedics begin CPR. CPR is performed with manual compressions as no mechanical CPR device is available. After administering 1mg of epinephrine ROSC is noted with a bradycardic rhythm ( Figure 2 ). They are unable to feel a pulse and resume CPR. Intubation is attempted, but unsuccessful. Current 85mA.
Case: You are the Chief of your local Fire and EMS Department, and an individual contacts you saying […] The post SGEM#380: OHCAs Happen and You’re Head Over Heels – Head Elevated During CPR? first appeared on The Skeptics Guide to Emergency Medicine. Date: October 18th, 2022 Reference: Moore et al.
Defibrillation Strategies for Refractory Ventricular Fibrillation. Defibrillation Strategies for Refractory Ventricular Fibrillation. He has been an ACLS instructor for close to 30 years and notably his first publication focused on out-of-hospital defibrillation. Defibrillation Strategies for Refractory Ventricular Fibrillation.
A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. You are the first provider on scene with Emergency Medical Services (EMS) and start high-quality Cardiopulmonary Resuscitation (CPR). Date: December 6th , 2018 Reference: Perkins et al.
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.
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.
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.
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.
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.
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 ).
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.
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.
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?
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?
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.
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.)
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.*
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.
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.
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?
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.
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."
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.
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.
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.
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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