EMS 12-Lead

MARCH 30, 2024

As this case shows, electrical capture isn't always possible at lower currents, especially with pads placed in a standard anterolateral "defibrillation" position. Escalating directly to TCP requires a certain technical acumen to ensure its efficacy. The anterior-posterior position, however, was 80% more likely to gain capture.

CPR 312

CPR Paramedic Ambulance Defibrillator 312

Emergency Medicine Cases

NOVEMBER 5, 2019

Sarah Reid on pediatric appendicitis risk calculator, Sheldon Cheskes & Mark Ramzy on double defibrillation for refractory ventricular fibrillation, Hans Rosenberg & Krishan Yadav on cellulitis clinical pearls, Anand Swaminathan on serratus anterior block, Brit Long on recognition of toxic shock syndrome, Justin Morgenstern on tranexamic acid (..)

Defibrillator 130

Defibrillator EMS 130

St. Emlyn's

JUNE 14, 2024

St.Emlyn's - Emergency Medicine #FOAMed This secondary analysis of the DOSE VF trial highlights double sequential external defibrillation (DSED) as a superior strategy over standard and vector change defibrillation for refractory ventricular fibrillation (RVF) in out-of-hospital cardiac arrest, improving survival rates and neurological outcomes (..)

Defibrillator 112

Defibrillator 112

The Skeptics' Guide to EM

JULY 22, 2023

We should focus more on high-quality CPR and early defibrillation for shockable rhythms and less on type of supraglottic airway device. The SGEM has also covered prehospital intubation using supraglottic devices for out-of-hospital cardiac arrests (OCHAs) with PA Missy Carter ( SGEM#247 and SGEM#396 ).

Emergency Medical Services 245

Emergency Medical Services Defibrillator CPR EMS 245

The Skeptics' Guide to EM

APRIL 27, 2024

This is because of the ease of finding anatomic landmarks and their location away from other procedures like defibrillation, CPR, and airway management. The classic location for IO placement is the tibial plateau.

ICU 233

ICU Defibrillator Paramedic CPR 233

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.

Defibrillator 52

Defibrillator CPR Life Support EMS 52

ACEP Now

JULY 7, 2023

2 Standard management for VT and VF involves the use of electrical defibrillation, high-quality chest compressions, and epinephrine. Initial guidelines defined “refractory” as VT or VF occurring despite three shocks from a cardiac defibrillator. Tips for use of dual sequence defibrillation 11 : Use the same model of defibrillator.

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

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.

Defibrillator 130

Defibrillator CPR EMS 130

The Skeptics' Guide to EM

OCTOBER 24, 2020

You abandon your coffee order and quickly head next-door, where you are able to start cardiopulmonary resuscitation (CPR) and direct a bystander to find the store’s automated external defibrillator (AED) while waiting for emergency medical services (EMS) to arrive. Unfortunately, most patients don’t receive these crucial interventions.

CPR 130

CPR Defibrillator Advanced Life Support Emergency Medical Services 130

Emergency Medicine Cases

JULY 3, 2018

The post BCE 73 Esmolol in Refractory Ventricular Fibrillation appeared first on Emergency Medicine Cases.

Defibrillator 130

Defibrillator Epinephrine EMS 130

The Skeptics' Guide to EM

OCTOBER 22, 2022

This includes epinephrine for OHCA, target temperature management, mechanical CPR, supraglottic airways, steroids, hands on defibrillation and many more topics. Background: We have covered Out of Hospital Cardiac Arrests (OHCAs) many, many times on the SGEM.

CPR 130

CPR Defibrillator Epinephrine Firefighter 130

Dr. Smith's ECG Blog

APRIL 2, 2024

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. There was no bystander CPR.

Defibrillator 133

Defibrillator Coronary Epinephrine CPR 133

Dr. Smith's ECG Blog

JULY 25, 2024

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. They started CPR. EMS arrived and found him in Ventricular Fibrillation (VF).

Defibrillator 125

Defibrillator Coronary Epinephrine ACS 125

St. Emlyn's

OCTOBER 21, 2024

St.Emlyn's - Emergency Medicine #FOAMed Should we use AP or AL pad position first for defibrillation in VF/VT cardiac arrest. Critical appraisal of an observational study in JAMA suggests a better outcome with AP, but there are many biases in this study. FOAMed @stemlyns The post JC: AP or AL pad position for first choice shock in VF?

ALS 106

ALS OR Defibrillator 106

EMDocs

OCTOBER 25, 2024

3: Does Defibrillator Pad Placement Matter for OHCA? Source Initial Defibrillator Pad Position and Outcomes for Shockable Out-of-Hospital Cardiac Arrest. Source Emergency Department Blood Pressure Treatment and Outcomes in Adults Presenting with Severe Hypertension. West J Emerg Med. 2024;25(5):680-689. #3: JAMA Netw Open. 2024.31673.

Defibrillator 94

Defibrillator Emergency Department ALS OR 94

EMDocs

JUNE 29, 2024

Spoon Feed This secondary analysis of the DOSE VF trial found that DSED (dual sequence external defibrillation) was the superior strategy for obtaining ROSC and functional neurologic outcome regardless of whether the patient was in recurrent VF or shock-refractory VF after three standard defibrillation shocks.

Defibrillator 95

Defibrillator Emergency Department ED OR 95

Dr. Smith's ECG Blog

APRIL 24, 2015

Again, it is common to have an ECG that shows apparent subendocardial ischemia after resuscitation from cardiac arrest, after defibrillation, and after cardioversion. Much depends on the post resuscitation ECG and its evolution shortly after defibrillation. Does this patient have ACS? Should he necessarily go to the cath lab?

Defibrillator 52

Defibrillator ACS CAD STEMI 52

The Skeptics' Guide to EM

SEPTEMBER 29, 2018

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. Case: A 46-year-old man has a cardiac arrest at home, witnessed by family.

BLS 130

BLS Defibrillator Critical Care CPR 130

The Skeptics' Guide to EM

SEPTEMBER 23, 2017

Bystander high-quality CPR can buy you some time until defibrillation. We know that rapid application of electricity to defibrillate shockable arrhythmias save lives. There are five steps in the Chain-of-Survival for OHCA: Most of us can agree with the first three steps. You need to recognize an arrest and activate your EMS system.

Life Support 130

Life Support CPR Advanced Life Support Defibrillator 130

The Skeptics' Guide to EM

DECEMBER 7, 2018

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. You are the first provider on scene with Emergency Medical Services (EMS) and start high-quality Cardiopulmonary Resuscitation (CPR). He is unsuccessfully shocked.

Epinephrine 130

Epinephrine Life Support Advanced Life Support Defibrillator 130

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). Case: A paramedic crew responds to a 54-year-old male in cardiac arrest at a private residence.

CPR 130

CPR Defibrillator BLS Paramedic 130

Medgadget

NOVEMBER 7, 2022

“All of the cells inside the heart get hit at one time, including the pain receptors, and that’s what makes pacing or defibrillation painful,” said Philipp Gutruf, a researcher involved in the study. Moreover, when electrical signals are sent to the heart, every cell receives the shock, often leading to pain and discomfort.

Defibrillator 103

Defibrillator OR 103

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). After good ECMO flow was established, she was successfully defibrillated. Here is a case of ECMO defibrillation with near shark fin that was due to proximal LAD occlusion. The K was normal.

Defibrillator 52

Defibrillator CPR Coronary CAD 52

Medgadget

MAY 1, 2023

“One of the challenges for current pacemakers and defibrillators is that they are difficult to affix onto the surface of the heart,” said Igor Efimov, one of the creators of the new technology. “Defibrillator electrodes, for example, are essentially coils made of very thick wires.

Defibrillator 111

Defibrillator 111

EMDocs

SEPTEMBER 14, 2024

4: VF or VT – Earlier Defibrillation Is Better? Source The impact of time to defibrillation on return of spontaneous circulation in out-of-hospital cardiac arrest patients with recurrent shockable rhythms. Source Management of Pustules and Vesicles in Afebrile Infants ≤60 Days Evaluated by Dermatology. Pediatrics. doi: 10.1542/peds.2023-064364.

Defibrillator 96

Defibrillator STEMI Emergency Department OR 96

Dr. Smith's ECG Blog

JUNE 9, 2024

We also gave insulin and furosemide (which take much longer to have their effect) After episodes of asystole and VF with defibrillation, she obtained ROSC and this 12-lead was recorded: The monitor around this time was NOT showing a very wide complex What do you think? How would you treat?

Defibrillator 101

Defibrillator Epinephrine OR 101

University of Maryland Department of Emergency Med

NOVEMBER 7, 2022

DOSE VF (DOuble SEquential External Defibrillation for Refractory VF) Trial Background - High quality data regarding the use of. Click to view the rest

Defibrillator 40

Defibrillator 40

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

VF was refractory to amiodarone, lidocaine, double-sequential defibrillation, esmolol, etc. Then the patient would have been taken to the critical care area with a defibrillator at his side while waiting for the cath lab to be ready. Resuscitative attempts were initiated quickly. Eventually asystole, and the patient died.

Defibrillator 136

Defibrillator Coronary STEMI CPR 136

International Journal of Paramedicine

OCTOBER 8, 2024

Measures of ventilation rates, singular tidal volume and one-minute volume were taken for comparison against international recommendations. Results: The SMART and Adult BVM mean ventilation rates were within recommended guideline parameters (i.e., 10–12 BPM).

Paramedicine 97

Paramedicine Paramedicine Defibrillator Paramedic 97

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? His point-of-care labs return with a potassium of 3.4

Defibrillator 109

Defibrillator CPR Epinephrine Life Support 109

Dr. Smith's ECG Blog

JULY 21, 2024

He required multiple defibrillations within a period of a few hours. This time, the arrhythmia did not spontaneously terminate — but rather degenerated to VFib, requiring defibrillation. Some episodes of PMVT would terminate spontaneously — but on many occasions, the PMVT degenerated to VFib, requiring defibrillation.

Defibrillator 131

Defibrillator Coronary ALS STEMI 131

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. COR 2b, LOE C-LD. COR 3, No benefit, LOE B-R. COR 2b, LOE B-R. COR 2b, LOE C-LD.

Epinephrine 98

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.

E-9-1-1 98

E-9-1-1 Defibrillator CPR STEMI 98

Dr. Smith's ECG Blog

JANUARY 2, 2025

Because she has cardiomyopathy and ventricular dysrhythmias, the pacer included an Implanted Cardioverter-Defibrillator (ICD) Echo 6 days later after CRT: Normal estimated left ventricular ejection fraction. The septum is punctured with the active fixation screw of the lead - so essentially you bore the septum with the screw helix."

Coronary 116

Coronary OR Defibrillator ALS 116

The Skeptics' Guide to EM

MARCH 2, 2019

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. What should you tell him? Background: We have covered OHCA many times on the SGEM.

CPR 130

CPR Firefighter Paramedic Defibrillator 130

The Skeptics' Guide to EM

JANUARY 9, 2021

OHCA was defined as persons found apneic and without a pulse who underwent either external defibrillation (bystanders or EMS) or chest compressions. JAMA 2020 * Population: Adults 18 years and older with non-traumatic OHCA between 2011 and 2015treated by 192 EMS agencies in the USA.

EMS 130

EMS Emergency Medical Services CPR Critical Care 130

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Defibrillation is the treatment of choice in these cases but does not often result in sustained ROSC ( Kudenchuk et al 2006). Background: The American Heart Association estimates there are approximately 350,000 EMS-assessed out-of-hospital cardiac arrests (OHCAs) in the United States per year.

EMR 130

EMR Coronary Defibrillator Life Support 130