EMS 12-Lead

AUGUST 22, 2022

They are not premature, by definition. We can, therefore, put down the defibrillation pads, set aside the amiodarone, and look further at the ECG. The blue arrows show RBBB morphology, and it’s tempting to deploy a compulsory diagnosis of PVC’s, but remember: these wide QRS complexes arrive subsequent to a regularly timed P wave.

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

Dr. Smith's ECG Blog

OCTOBER 28, 2013

She was found to be in ventricular fibrillation and was defibrillated 8 times without a single, even transient, conversion out of fibrillation. She was immediately intubated during continued compressions, then underwent a 9th defibrillation, which resulted in an organized rhythm at 42 minutes after initial arrest. It was stented.

Defibrillator 52

Defibrillator ACS CPR STEMI 52

Dr. Smith's ECG Blog

OCTOBER 23, 2023

She was successfully revived after several rounds of ACLS including defibrillation and amiodarone. E lectrical A lternans : Definition/Features/Mechanisms Electrical alternans — is a beat-to-beat variation in any one or more parts of the ECG recording. On arrival to the ED the patient was intubated with normal vital signs.

ICU 130

ICU OR Defibrillator EMS 130

Dr. Smith's ECG Blog

SEPTEMBER 21, 2020

He was found in ventricular fibrillation and defibrillated, then brought to a local ED which does not have a cath lab. I would also measure the ST segments and determine if it was a STEMI by millimeter criteria (as outlined in the 4th Universal Definition of MI ), or OMI without STEMI. And the article was rejected.

STEMI 52

STEMI Defibrillator ED ACS 52

Dr. Smith's ECG Blog

AUGUST 17, 2019

So this is a normal amount of STE in V2 and V3, defined by Universal Definition of MI as up to 2.0 So there is definitely no STEMI, and the STE is normal. Defibrillated out of v fib in the cath lab. The remarkable ECG findings are multiple: There are small-but-definite Q waves in each of the inferior leads ( RED arrows ).

STEMI 52

STEMI Defibrillator ED OR 52

Dr. Smith's ECG Blog

SEPTEMBER 12, 2023

Treatment is by ICD ( implantable cardioverter defibrillator ). Regarding Today's ECG — I chose the lead with the most ST-T wave deviation ( = lead V2 in Figure-1 ) to draw in 2 vertical BLUE lines highlighting the point where I thought definite “peaking of the T wave" is seen.

Defibrillator 68

Defibrillator OR 68

Dr. Smith's ECG Blog

APRIL 29, 2020

She was never defibrillated. The ultimate reason for the long QT was never definitively determined. Drug-induced QT interval cannot be completely ruled out, but the tox consult found the she had definitely not overdosed and did not believe that therapeutic doses would do this. What do you think?

Epinephrine 52

Epinephrine Defibrillator Coronary Overdose 52

Dr. Smith's ECG Blog

FEBRUARY 13, 2023

In the hope of reinforcing Dr. McLaren's case for immediate cath in today's patient — I thought it worthwhile to take another look at the subtle-but-definitely-present ECG findings that were clearly evident in the initial tracing ( Figure-1 ). First troponin I was 150 ng/L (normal <26 in males and <16 in females) and peak was 7,500.

STEMI 52

STEMI Paramedic Coronary ALS 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

She was defibrillated and resuscitated. To Emphasize: The reason definitive diagnosis is important in today's case — is that the senior ED physician interpreted ECG #1 as "nothing too exciting". Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Emergency Department 52

Emergency Department E-9-1-1 Coronary STEMI 52

Dr. Smith's ECG Blog

MARCH 15, 2023

We examined the effect of ibutilide, a class III antiarrhythmic agent, on the energy requirement for atrial defibrillation and assessed the value of this agent in facilitating cardioversion in patients with atrial fibrillation that is resistant to conventional transthoracic cardioversion. 25, 2022 ).

ALS 52

ALS OR Defibrillator ED 52

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

VF was refractory to amiodarone, lidocaine, double-sequential defibrillation, esmolol, etc. Suppose the OMI had been recognized, or suppose another ECG had been recorded and it showed definite OMI. But as it was, the delay to defibrillation was not long and it may be that nothing could have saved him.

Defibrillator 135

Defibrillator Coronary STEMI CPR 135

The Skeptics' Guide to EM

MARCH 2, 2019

They had a difficult time getting a definitive airway pre-hospital. Key to survival is high-quality CPR and early defibrillation. Case: EMS arrive to your emergency department with a 68-year-old man post cardiac arrest patient. It required multiple attempts which caused several prolonged interruptions in CPR. What should you tell him?

CPR 130

CPR Firefighter Paramedic Epinephrine 130

Dr. Smith's ECG Blog

JULY 21, 2024

He required multiple defibrillations within a period of a few hours. There is no definite evidence of acute ischemia. (ie, This time, the arrhythmia did not spontaneously terminate — but rather degenerated to VFib, requiring defibrillation. An ICD ( Implantable Cardioverter Defibrilator ) was placed prior to discharge.

Defibrillator 131

Defibrillator Coronary ALS STEMI 131

Dr. Smith's ECG Blog

JANUARY 15, 2024

Rhythm C: This telemetry strip from an older adult was initially thought to need defibrillation. Rhythm B: This patient was seen in the ED — and thought to be in AFlutter with 4:1 AV conduction. Figure 1 – Examples of artifactual distortion ( excerpted from my ECG Blog ) — that resulted in arrhythmia misdiagnosis.

Critical Care 64

Critical Care Defibrillator OR ALS 64

Dr. Smith's ECG Blog

OCTOBER 20, 2013

She was never seen to be in ventricular fibrillation and was never defibrillated. 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 hypotensive in the ED and her bedside echo showed a normal RV and LV. BP gradually rose.

STEMI 52

STEMI Coronary ACS Emergency Department 52

Dr. Smith's ECG Blog

MAY 6, 2019

Cardioversion/defibrillation. This definition was changed following an expert consensus panel in 2013 — so that at the present time, all that is needed to diagnose Brugada Syndrome is a spontaneous or induced Brugada-1 ECG pattern, without need for additional criteria. Acute febrile illness. Variations in autonomic tone. Hypothermia.

STEMI 52

STEMI Defibrillator OR ALS 52

Don't Forget the Bubbles

JULY 26, 2023

As she has had an out of hospital arrest, the likely path would be (following cardiac work up) to be offered an implantable defibrillator (ICD). Depending on what you read and the exact definition applied to ‘recurrence’ of SVT somewhere between 30-50% of infants will not require therapy beyond 12-18 months.

ALS 98

ALS ED OR CPR 98

Dr. Smith's ECG Blog

SEPTEMBER 20, 2018

He was defibrillated immediately and had return of normal mental status. Cath lab activation was cancelled but the transfer was accepted for urgent cardiology evaluation. 40 minutes after the first ECG, just before transport, a repeat ECG was obtained: Continued, active OMI of the anterior, lateral, and inferior walls.

STEMI 52

STEMI Coronary ACS Defibrillator 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

This definition was changed following an expert consensus panel in 2013 — so that at the present time, all that is needed to diagnose Brugada Syndrome is a spontaneous or induced Brugada-1 ECG pattern, without need for additional criteria.

E-9-1-1 52

E-9-1-1 CAD STEMI OR 52

Paramedic Training Spot

NOVEMBER 29, 2021

You must also pass your practical examinations, which can include things like HARE traction splints, manual airway management, or proper CPR and AED (Automated External Defibrillator) use. In order to stay up to date, you must take something called a CEU, or Continuing Education Unit.

EMT 52

EMT EMT EMR Emergency Medical Technician 52

Dr. Smith's ECG Blog

FEBRUARY 17, 2023

Treatment is by ICD ( implantable cardioverter defibrillator ). Regarding ECG #1 — I chose the lead with the most ST-T wave deviation ( = lead V2 in Figure-1 ) to draw in 2 vertical BLUE lines highlighting the point where I thought definite “peaking of the T wave" is seen.

STEMI 52

STEMI Defibrillator OR ED 52

Dr. Smith's ECG Blog

APRIL 9, 2025

We rapidly defibrillated her, and with return of normal sinus rhythm. Several minutes later the patient developed V-fib again > 200J defibrillation with return to NSR. Rapid sequence intubation was performed for airway protection in setting of recurrent V-fib and defibrillations. Chest X-ray also showed pulmonary edema.

Defibrillator 63

Defibrillator STEMI ED OR 63

Dr. Smith's ECG Blog

DECEMBER 27, 2024

The submitter started the patient on amiodarone and arranged implantation of a defibrillator. == MY Comment , by K EN G RAUER, MD ( 12/27 /2024 ): == Superb discussion by Dr. Frick in today's case, that highlights a series of important points regarding the ECG recognition of stable VT ( V entricular T achycardia ).

Coronary 121

Coronary Defibrillator ACS ED 121

Dr. Smith's ECG Blog

MARCH 25, 2025

In this case, you should get a second defibrillator and perform double sequential external defibrillation (DSED). Simply attach a second defibrillator as shown in the diagram below and deliver max shocks from both devices simultaneously. In the second case, the patient never converted meaning the shock did not do its job at all.

Defibrillator 63

Defibrillator ACS Coronary ALS 63

Dr. Smith's ECG Blog

DECEMBER 31, 2024

Soon after the witnessed occlusion, the patient suffered ventricular fibrillation arrest, from which he was immediately resuscitated with 1 defibrillation. Final Diagnosis: "STEMI" (of course, as you can see in the ECGs above, this is not true, by definition this was NSTEMI. In other words, millimeters really don't matter!

Coronary 118

Coronary ACS STEMI CAD 118

Dr. Smith's ECG Blog

MARCH 6, 2025

Fortunately , you don't need to make a definite diagnosis. Second , when you have a rhythm problem, you are likely to be able to fix the problem with electricity (cardioversion, defibrillation, pacing). But the superior axis with positive QRS in V1 is difficult to reconcile with an accessory pathway.

Coronary 95

Coronary ICU OR Defibrillator 95

FOAMfrat

NOVEMBER 25, 2024

Definitive care for an intrapartum cardiac arrest is a maternal perimortem cesarian section, which may be performed by any emergency physician. Sure, we still do CPR, defibrillate as needed, and give Epinephrine based upon our local guidance. These cases are incredibly sad and rarely yield survivable outcomes, for the mother or fetus.

Epinephrine 105

Epinephrine CPR Operating Room Plasma 105