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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.
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. Cardiac arrest #3: ST depression, Is it STEMI? This patient was witnessed by bystanders to collapse.
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
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.
He reports that this chest pain feels different than prior chest pain when he had his STEMI/OMI, but is unable to further describe chest pain. VF was refractory to amiodarone, lidocaine, double-sequential defibrillation, esmolol, etc. Sensitivity was 87% for OMI in our validation study (it was 34% for STEMI criteria).
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.
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.
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. If you want to understand aVR, read this.]
Here is his ED ECG: There is obvious infero-posterior STEMI. What are you worried about in addition to his STEMI? 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. There is atrial fibrillation.
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.
Medics found her apneic and pulseless, began CPR, and she was found to be in asystole. She was never seen to be in ventricular fibrillation and was never defibrillated. Note that they finally have laid to rest the new or presumably new LBBB as a criteria for STEMI. With ventilations and epinephrine, she regained a pulse.
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. He had multiple cardiac arrests with ROSC regained each time.
to greatly decrease risk (although in STEMI, the optimal level is about 4.0-4.5 Here are other posts on hyperK, large calcium doses for hyperK, and ventricular tachycardia in hyperK Weakness, prolonged PR interval, wide complex, ventricular tachycardia Very Wide and Very Fast, What is it? How would you treat? If the patient is at 1.8,
Several 200 J shocks did not terminate the VF, so a second defibrillator was applied for double sequential defibrillation with 400 J. She was defibrillated perhaps 25 times. Propranolol versus Metoprolol for treatment of electrical storm in patients with implantable cardioverter-defibrillator. SanzRuiz, R., Solis, J., &
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