Dr. Smith's ECG Blog

APRIL 24, 2015

Here was his initial ED ECG: There is atrial fibrillation with a rapid ventricular response. Again, it is common to have an ECG that shows apparent subendocardial ischemia after resuscitation from cardiac arrest, after defibrillation, and after cardioversion. A middle-aged male had a V Fib arrest. He had a history of CAD with CABG.

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Defibrillator ACS CAD STEMI 52

EMDocs

NOVEMBER 19, 2024

2 If Torsade de Pointes develops, defibrillate the patient if unstable, give magnesium, and consider overdrive pacing. In: Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, eds. His roommate found an empty pill bottle on the floor next to him. 1,2 Consider lidocaine if sodium bicarbonate fails. 1 Class IA (e.g.,

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Overdose EMS Emergency Medical Services OR 111

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

He is interested and experienced in healthcare informatics, previously worked with ED-directed EMR design, and is involved in the New York City Health and Hospitals Healthcare Administration Scholars Program (HASP). She arrives in the emergency department (ED) with decreased level of consciousness and shock.

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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. You can also measure and monitor symptoms using the clinical opiate withdrawal scale (COWS).

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CPR Naloxone Overdose Defibrillator 52

The Skeptics' Guide to EM

FEBRUARY 25, 2023

Case: A 6-month-old boy presents to the emergency department (ED) with three days of worsening cough, cold symptoms, and fever. Background: We often manage patients in cardiac arrest in the ED or the intensive care unit (ICU). Pediatric Crit Care Med. Parents note that he has been progressively more tired and difficult to arouse.

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CPR ICU Critical Care Defibrillator 130

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

The Skeptics' Guide to EM

JANUARY 9, 2021

Case: During a busy emergency department (ED) shift the paramedic phone rings. OHCA was defined as persons found apneic and without a pulse who underwent either external defibrillation (bystanders or EMS) or chest compressions. CPR is currently in progress with a single shock having been delivered.

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EMS Emergency Medical Services CPR Critical Care 130

EMDocs

JANUARY 3, 2024

He has been taking increased doses of torsemide without improvement in his symptoms and was directed to the ED for inpatient therapy. Now, a remote outpatient pulmonary arterial pressure monitor and other heart failure detection devices (Table 1) are available that you may begin to see in your ED.

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Defibrillator Allergic Reaction ED ALS 116

EMDocs

JANUARY 8, 2024

This post will focus on the key parts of the guideline that affect ED evaluation and management. With respect to timing, for cardiac arrest with a shockable rhythm, it may be reasonable to administer epinephrine after initial defibrillation attempts have failed. COR 2b, LOE C-LD. COR 3, No benefit, LOE B-R. COR 2b, LOE B-R.

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Epinephrine Defibrillator Coronary CPR 98

Dr. Smith's ECG Blog

JULY 14, 2023

A 40-something with persistent Ventricular Fibrillation presented after attempted prehospital resuscitation A 40-something with no previous cardiac history presented to the ED in persistent Ventricular Fibrillation after attempted prehospital resuscitation. Finally, head-up CPR (which was not used here), makes for better resuscitation.

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E-9-1-1 Defibrillator CPR STEMI 98

Dr. Smith's ECG Blog

JUNE 21, 2023

In this medical system, the EMS provider can then be routed to the ED or to a type of urgent care facility that is open 24 hrs/day and staffed by a primary care provider. In this case, the EMS provider was routed to the urgent care facility. The LCX was noted to be "subtotally stenosed" at the time of cath.

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STEMI Coronary Defibrillator EMS 98

EMDocs

FEBRUARY 9, 2024

Defibrillator pads are placed and you give 2 g IV magnesium over ten minutes. It is recommended to use an unsynchronized setting as the defibrillator may not be able to track the R-wave in the polymorphic waveform. A simplified standard protocol for ED management is below 3. The patient is awake and protecting her airway.

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Defibrillator OR ED ALS 98

EMS 12-Lead

MARCH 19, 2023

Despite immediate chest compressions, and multiple rounds of defibrillation, he could not be resuscitated. Anyone who has worked emergency medicine for any length of time immediately recognizes this statement as a cry for help and equally portends dire change. He became unconscious as the monitor displayed VF.

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Coronary STEMI Paramedic Defibrillator 130

ACEP Now

DECEMBER 6, 2024

After the fourth defibrillation attempt, 200 mcg IV NTG was administered, resulting in immediate return of spontaneous circulation with a junctional bradycardia rhythm. Dr. Rad is ED faculty at Wellstar Kennestone Regional Medical Center in Marietta, Ga., Click to enlarge.) and at Naples Community Hospital in Naples, Fla.

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Coronary Life Support ALS Emergency Department 98

Dr. Smith's ECG Blog

SEPTEMBER 29, 2024

On arrival to the ED, this ECG was recorded: What do you think? Although one may have all kinds of ischemic findings as a result of cardiac arrest (rather than cause of cardiac arrest), this degree of ST elevation and HATW is all but diagnostic of acute proximal LAD occlusion. This prompted cath lab activation.

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STEMI Coronary Defibrillator OR 109

EMS 12-Lead

AUGUST 22, 2022

We can, therefore, put down the defibrillation pads, set aside the amiodarone, and look further at the ECG. Chou’s Electrocardiography in Clinical Practice (6th ed). Paradoxically, though, the third green arrow identifies a QRS that is more narrow than the RBBB complexes surrounding it. Circulation, Vol 139, No 16, 1974-76.

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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 arrived in the ED 37 minutes after 911 was called, with continuing CPR. She arrived in the ED 37 minutes after 911 was called, with continuing CPR. at the time of the ECG.

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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. On arrival to the ED the patient was intubated with normal vital signs. By EMS report, open pill bottles were found nearby at the scene, including quetiapine, fluoxetine, hydroxyzine, and gabapentin.

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ICU OR Defibrillator EMS 130

NCOAE

AUGUST 12, 2022

Here, we present them in alphabetical order: ABC – Airway, Breathing and Circulation – “This is the Golden Rule of emergency medical professionals” AED – Automated External Defibrillator – The device that delivers electric shock to the heart of patients experiencing sudden cardiac arrest A-EMT – Advanced EMT ALS – Advanced Life Support Anaphylaxis— (..)

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EMS EMT EMT Emergency Medical Technician 52

Dr. Smith's ECG Blog

OCTOBER 3, 2017

Here is his ECG on presentation to the ED, approximately 45 minutes after onset of pain, but with pain improving since onset: What is your interpretation? The initial ECG was interpreted as "normal" by the computer ( Algorithm: Marquette GE / 12SL ) and "no acute ischemic changes" by the ED physician.

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CPR Defibrillator STEMI ED 52

Dr. Smith's ECG Blog

OCTOBER 21, 2022

Submitted by Dr. Arjun J V in India, An elderly patient presented to the ED with multiple complaints. As worrisome as the initial recording in leads I and II look — a glance at lead III should immediately reassure us that defibrillation is not needed! An ECG was recorded in triage: What do you think?

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Defibrillator OR ED 52

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. Here is the initial ED ECG: This is pretty obviously and inferior posterior OMI, right? The patient was defibrillated, and then taken to the nearest ED where ECG #1 was obtained ( Figure-1 ).

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STEMI Defibrillator ED ACS 52

Dr. Smith's ECG Blog

APRIL 29, 2020

She was never defibrillated. I was texted this ECG in real time, but it turns out to actually be the 2nd one recorded in the ED. ECG #4 — This is the 3rd ECG that was done in this case ( obtained ~1 hour after arrival in the ED ). As was seen in this case — defibrillation and/or overdrive pacing may be needed.

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Defibrillator Epinephrine Coronary Overdose 52

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

Submitted by Dr. George Mastoras (Twitter @georgemastoras), written by Jesse McLaren It’s a busy day in the ED when you’re sent another ECG to sign off from a patient at triage. A healthy 45-year-old female presented with chest pain, with normal vitals.

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OR STEMI ACS Coronary 65

Broome Docs

JANUARY 30, 2023

Defibrillation Strategies for Refractory Ventricular Fibrillation. So please, sit back relax, have a quiet drink and enjoy some of the nerdiest medical podcasting out there. DOSE VF: Cheskes S, Verbeek PR, Drennan IR, McLeod SL, Turner L, Pinto R, Feldman M, Davis M, Vaillancourt C, Morrison LJ, Dorian P, Scales DC. N Engl J Med. 2022 Nov 6.

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E-9-1-1 Defibrillator Emergency Department ALS 52

Dr. Smith's ECG Blog

AUGUST 17, 2019

Defibrillated out of v fib in the cath lab. For clarity — I’ve labeled a number of KEY findings in the initial ECG performed in the ED ( = E CG # 1 in Figure-1 ). Figure-1: The initial ECG done in the ED ( See text ). "Bedside echo revealed anteroseptal wall motion abnormality at which point I activated a code STEMI.

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STEMI Defibrillator ED OR 52

Dr. Smith's ECG Blog

FEBRUARY 13, 2023

If the patient only had these two ECGs recorded, it would have missed the transient time between them which were STEMI positive, and the patient would then have arrived at the ED as “serial ECGs STEMI negative." There was 100% proximal LAD occlusion, EF was 55% with severe hypokinesis to mid-distal septum and apex.

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STEMI Paramedic Coronary ALS 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. Methods. . =

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ALS OR Defibrillator ED 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

When the ICD was finally interrogated, the syncopal events and shocks correlated with two VF events that were defibrillated successfully. That this might happen should not be surprising — since the patient's chest pain was already ongoing for 3 hours prior to arrival in the ED.

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ACS Coronary Defibrillator STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

They transported to the ED. The history, obtained subsequently, is interesting: The patient had been seen at an outside ED 2 days prior and the K was 2.5 Hospital admission had been recommended, but she left that ED against medical advice. What does a heart look like on ultrasound when the EKG looks like that?

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Plasma STEMI Defibrillator Overdose 40

Dr. Smith's ECG Blog

JUNE 27, 2024

A patient had a cardiac arrest with ventricular fibrillation and was successfully defibrillated. Here was his initial ED ECG: Formal interpretation by interventional cardiologist: There is "Non-diagnostic" ST Elevation in V2-V4 and aVL. As per Dr. Smith — the intuitive answer should be obvious.

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Defibrillator STEMI Coronary ALS 112

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."

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

EMS 12-Lead

MARCH 30, 2024

On ED arrival ROSC is achieved. As this case shows, electrical capture isn't always possible at lower currents, especially with pads placed in a standard anterolateral "defibrillation" position. They are unable to feel a pulse and resume CPR. The receiving staff suspects pulmonary embolism due to S1Q3T3 on the ECG and administers TPA.

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CPR Paramedic Ambulance Defibrillator 312

Dr. Smith's ECG Blog

JUNE 13, 2024

Click here to sign up for Queen of Hearts Access Case A 58-year-old woman presented to the ED with burning chest pain that started 2-3 hours earlier while sitting on a porch swing. Here is her ED EKG: What do you think? She was successfully defibrillated and taken back to the ED. But which artery? The family sued.

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Defibrillator STEMI EMT EMT 91

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.

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Defibrillator Coronary STEMI CPR 134

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). His blood sugar was normal en route to the ED, and his initial rhythm on the cardiac monitor was asystole. It is unclear how long he was down.

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Defibrillator CPR Epinephrine Life Support 111

Dr. Smith's ECG Blog

APRIL 6, 2018

EMS report was that the patient had unknown down time with unwitnessed arrest, found initially in VFib arrest, defibrillated x1 followed by PEA arrest alternating with asystolic arrest during transport. Upon closer inspection, the defibrillator's monitor had assigned a spike for every large T wave as well as every QRS complex.

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Defibrillator ICU EMS Plasma 52