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? 2,3 Multiple published studies have addressed treatment of ventricular fibrillation with defibrillation and medications such as amiodarone and lidocaine.

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Defibrillator E-9-1-1 ALS Epinephrine 52

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 (..)

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Defibrillator 114

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 (..)

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Defibrillator EMS 130

JEMS

APRIL 16, 2025

An initiative using aerial drones to deliver defibrillators, EpiPens and other medical supplies to local emergency scenes has been cleared for a test run.

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Defibrillator EMS 102

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 ).

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Emergency Medical Services Defibrillator CPR EMS 245

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.

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Defibrillator CPR Life Support EMS 52

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.

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ICU Defibrillator Paramedic CPR 231

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.

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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.

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Defibrillator CPR EMS 130

Emergency Medicine Cases

JULY 3, 2018

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

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Defibrillator Epinephrine 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.

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CPR Defibrillator Advanced Life Support Emergency Medical Services 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.

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CPR Defibrillator Epinephrine Firefighter 130

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?

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ALS OR Defibrillator 107

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.

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Defibrillator Emergency Department ALS OR 95

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).

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Defibrillator Coronary Epinephrine ACS 123

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.

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Defibrillator Emergency Department ED OR 96

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?

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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.

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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.

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CPR Life Support 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.

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Epinephrine Life Support Advanced Life Support Defibrillator 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.

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Defibrillator Coronary Epinephrine CPR 131

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.

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Defibrillator CPR Coronary CAD 52

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.

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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.

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CPR Defibrillator BLS Paramedic 130

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.

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Defibrillator STEMI Emergency Department OR 96

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

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Defibrillator 40

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.

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Defibrillator 111

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?

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Defibrillator Epinephrine OR 100

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).

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Paramedicine Paramedicine Defibrillator Paramedic 97

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.

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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.

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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."

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Coronary OR Defibrillator ALS 115

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.

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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.

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EMR Coronary Defibrillator Life Support 130

ESO

DECEMBER 18, 2024

Early CPR plays an important role in the American Heart Associations (AHA) Chain of Survival , which emphasizes recognizing symptoms quickly, activating 911, performing CPR, and practicing early defibrillation and post-resuscitation care.

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CPR Naloxone Overdose Defibrillator 52

EMDocs

NOVEMBER 19, 2024

2 If Torsade de Pointes develops, defibrillate the patient if unstable, give magnesium, and consider overdrive pacing. If the EKG is normal in an asymptomatic patient at 6 hours, there is low likelihood of cardiac complication. 1 If the EKG is abnormal or patient continues with AMS at 6 hours, admit for cardiac monitoring for 24 hours.

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Overdose EMS Emergency Medical Services OR 111

The Skeptics' Guide to EM

JULY 3, 2021

Paramedics managed to get return of spontaneous circulation after a single defibrillation, but the patient is still comatose on arrival. When paramedics arrived, they found him to be in cardiac arrest, with ventricular fibrillation on the monitor. The charge nurse turns to you and asks: should I grab the ice packs?

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Paramedic Defibrillator ALS OR 130