The Skeptics' Guide to EM

JANUARY 9, 2021

JAMA 2020 Guest Skeptic: Mike Carter is a former paramedic and current PA practicing in pulmonary and critical care as well as an adjunct professor of emergency medical services at Tacoma Community College. Case: During a busy emergency department (ED) shift the paramedic phone rings.

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EMS Emergency Medical Services CPR Critical Care 130

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

She arrives in the emergency department (ED) with decreased level of consciousness and shock. 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.

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EMR Coronary Defibrillator Life Support 130

EMDocs

NOVEMBER 19, 2024

2 If Torsade de Pointes develops, defibrillate the patient if unstable, give magnesium, and consider overdrive pacing. His roommate found an empty pill bottle on the floor next to him. If the EKG is normal in an asymptomatic patient at 6 hours, there is low likelihood of cardiac complication. 1 Class IA (e.g., procainamide), IC (e.g.,

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Overdose EMS Emergency Medical Services OR 111

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. Apart from high-quality CPR and early defibrillation, many other interventions we try lack a strong evidence base. Pediatric Crit Care Med.

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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.

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Defibrillator CPR Coronary CAD 52

Dr. Smith's ECG Blog

JUNE 21, 2023

You can subscribe for news and early access (via participating in our studies) to the Queen of Hearts here: [link] queen-form This EMS ECG was transmitted to the nearby Emergency Department where it was remotely reviewed by a physician, who interpreted it as normal, or at least without any features of ischemia or STEMI.

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STEMI Coronary Defibrillator EMS 98

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. No existing algorithm or literature guides the validity of a NTG strategy for vasospastic cardiac arrest in the emergency department. Click to enlarge.)

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Coronary Life Support ALS Emergency Department 98

EMDocs

JANUARY 3, 2024

1 Like other implantable devices, such as pacemakers and automated implantable cardioverter defibrillators (AICDs), they can be interrogated for valuable information by the patient ’ s cardiology team when the patient presents to the ED. It is likely that this device and future devices will become more common in patients presenting to the ED.

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Defibrillator Allergic Reaction ED ALS 114

FOAMcast

JANUARY 24, 2023

A small team of strangers, including an emergency medicine resident, Dr. Jason Tanner, and an emergency department technician, Angel, assembled to treat this passenger. Billy Frolick , a writer and our patient that day shares his perspective on his case with us.

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Defibrillator Emergency Department OR 52

EMDocs

FEBRUARY 9, 2024

Authors: Adam Roussas, MD, MBA, MSE // Reviewed by: Jamie Santistevan, MD ( @jamie_rae_EMdoc, EM Physician, Presbyterian Hospital, Albuquerque, NM); Manpreet Singh, MD ( @MPrizzleER ); and Brit Long, MD ( @long_brit ) Case A 40-year-old female presents to the emergency department for palpitations and lightheadedness.

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Defibrillator OR ED ALS 97

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting." She was defibrillated and resuscitated. Then she began complaining of severe dizziness and quickly went into ventricular fibrillation and resuscitation was initiated by hospital staff.

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

Dr. Smith's ECG Blog

OCTOBER 4, 2010

He was resuscitated with chest compressions and defibrillation and 1 mg of epinephrine. He arrived in the emergency department hemodynamically stable. This young male had ventricular fibrillation during a triathlon. On his bib it stated that he had a congenital heart disorder. His initial ECG is shown here.

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ACS Defibrillator Epinephrine STEMI 52

Broome Docs

OCTOBER 31, 2022

PMID: 35490863 Hands on defibrillation: Even if it’s safe, would it actually help? Ex vivo evaluation of personal protective equipment in hands-on defibrillation. PMID: 35942482 earing gloves, hands on defibrillation is probably safe. Emerg Med J. Resusc Plus. 2022 Aug 3;11:100284. doi: 10.1016/j.resplu.2022.100284.

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E-9-1-1 Defibrillator ICU Critical Care 52

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

Broome Docs

JANUARY 30, 2023

Defibrillation Strategies for Refractory Ventricular Fibrillation. Association of Chest Pain Protocol-Discordant Discharge With Outcomes Among Emergency Department Patients With Modest Elevations of High-Sensitivity Troponin. Outcomes of patients discharged from the pediatric emergency department with abnormal vital signs.

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

ECG Medical Training

JUNE 11, 2016

Additional Treatments Defibrillation pads were applied. The patient briefly considered refusing transport to the Emergency Department. Unfortunately, in this case the maneuver was attempted twice without success. IV access was achieved. 6 mg of adenosine was given rapid IV push followed by a 20 ml bolus of normal saline.

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Paramedic Defibrillator ALS Emergency Department 52

NAEMSP

APRIL 19, 2023

CPR is taken over by responding crews, and he is placed on a cardiac monitor/defibrillator. After several cycles of defibrillation, epinephrine, and amiodarone, the patient remains in cardiac arrest. Association between calcium administration and outcomes during adult cardiopulmonary resuscitation at the emergency department.

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E-9-1-1 Advanced Life Support Overdose CPR 52

NCOAE

MARCH 8, 2021

Recognizing the Difference Between EMTs, AEMTs, and Paramedics The National Registry of Emergency Medical Technicians (NREMT) — that’s the leading certification agency in the U.S. Advanced EMT: Advanced EMTs have higher level assessment skills and are permitted to administer about 20 different medications depending on their state license.

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EMT EMT Emergency Medical Technician AEMT 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chest pain for 3 hours prior to arrival. The screening physician ordered an EKG and noted his ashen appearance and moderate distress. Triage EKG: What do you think?

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ACS Coronary Defibrillator STEMI 52

The Skeptics' Guide to EM

MARCH 2, 2019

JAMA 2018 Guest Skeptic: Missy Carter, former City of Bremerton Firefighter/Paramedic, currently a physician assistant practicing in emergency medicine in the Seattle area and an adjunct faculty member with the Tacoma Community College paramedic program. Key to survival is high-quality CPR and early defibrillation.

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Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. It is unknown when this pain recurred and became constant.

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Defibrillator Coronary STEMI CPR 135

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The patient was rushed to the nearest emergency department (non-PCI facility) for stabilization. The arrhythmia spontaneously converted before defibrillation was achieved. Just prior to arrival he fell out of consciousness with the below ECG on the monitor. ECG #3 The above ECG shows a polymorphic VT at a rate of about 180 BPM.

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Coronary ACS Emergency Department Defibrillator 128

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). You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Am J Emerg Med. What would your next steps be? N Engl J Med.

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Defibrillator CPR Epinephrine Life Support 110

The Skeptics' Guide to EM

DECEMBER 2, 2017

He is currently deployed, practicing emergency medicine in an undisclosed location. Case: You are working a regular shift in the emergency department when you hear a code blue called. Cardiac Arrest: Pulselessness requiring chest compressions and/or defibrillation, with a hospital wide or unit based emergency response.

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CPR Defibrillator ALS Emergency Response 100

EMDocs

SEPTEMBER 23, 2023

A 23-year-old man with no significant medical history presents to the emergency department for evaluation of a syncopal episode. Patients with Brugada syndrome should have a prompt cardiology consultation for consideration of implantable defibrillator placement due to the high risk of sudden cardiac death.

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E-9-1-1 EMS ALS Defibrillator 105

Dr. Smith's ECG Blog

OCTOBER 20, 2013

She was never seen to be in ventricular fibrillation and was never defibrillated. Data collected included demographics, initial rhythm, EKG, emergency department (ED) CT and outcomes. We analyse disease-specific and emergency care data in order to improve the recognition of subarachnoid haemorrhage as a cause of cardiac arrest.

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STEMI Coronary ACS Emergency Department 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

Colin is an emergency medicine resident beginning his critical care fellowship in the summer with a strong interest in the role of ECG in critical care and OMI. A patient in their 40s with type 1 diabetes mellitus and hyperlipidemia presented to the emergency department with 5 days of “flu-like” illness. Edits by Willy Frick.

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Critical Care Defibrillator OR ALS 64

Dr. Smith's ECG Blog

JUNE 19, 2023

Written by Kaley El-Arab MD, edits by Pendell Meyers and Stephen Smith A 61-year-old male with hypertension and hyperlipidemia presented to the emergency department for chest tightness radiating to the back of his neck that has been intermittent for the past day or two. What do you think?

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STEMI ACS Coronary Defibrillator 52

Don't Forget the Bubbles

JULY 26, 2023

Prioritise listening to the first 30 minutes which given a good overview of aetiology and treatment (53 mins) Basics of cardiac rhythm problems in the ED Palpitations are a common reason for children to present to the emergency department, the majority of these will be benign from a cardiac perspective and instead related to stress or anxiety.

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ALS ED OR CPR 98

ECG & Echo Learning

JANUARY 18, 2023

I B ECG monitoring should start immediately and a defibrillator must be ready. I B Patients transferred to PCI centres can bypass the emergency department to undergo primary PCI without delay. STEMI , ST-segment elevation acute myocardial infarction ). due to reciprocal ST-segment depressions in V1, V2, V3).

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STEMI Coronary OR Defibrillator 40

ACEP Now

OCTOBER 28, 2024

Holy Foley A Rare Case of Iatrogenic Obstruction by Adam Heilmann, MD; Jessica Pelletier, DO; Jennifer Reyes Lin, MD, MPH Our patient is a 33-year-old male with spastic quadriparesis due to cerebral palsy with chronic indwelling suprapubic catheter (SPC) who presented to the emergency department (ED) due to concern for Foley catheter obstruction.

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Emergency Department Defibrillator Epinephrine EMS 52

Dr. Smith's ECG Blog

DECEMBER 22, 2010

After epinephrine, atropine, and defibrillation x 2, there was a return of pulses. Emergency Department Two-Dimensional Echocardiography in the Diagnosis of Nontraumatic Cardiac Rupture. A 65 yo woman had felt ill for 36 hours, had seen her MD but without undergoing a cardiac evaluation. Exact rhythm during arrest is uncertain.

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STEMI Defibrillator Epinephrine Emergency Department 40

Dr. Smith's ECG Blog

DECEMBER 20, 2024

The following ECG was obtained in the emergency department during active chest pain. This is the shock coil and identifies this device as a defibrillator. CRT-D is cardiac resynchronization therapy with defibrillation capability, like the CXR above. He said he had had three episodes of chest pain that day while urinating.

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Defibrillator Coronary ALS Emergency Department 102

FOAMfrat

DECEMBER 31, 2024

With that being said, the manufacturers say that CPR, medications, Defibrillation, Cardioversion, and Anything you would normally do are OKAY. We still defibrillate ventricular fibrillation just as we would any other patient. A Basic Approach to the LVAD Patient in the Emergency Department. Christian T. Nov 2, 2014).

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CPR Defibrillator Emergency Department Emergency Transportation 64

Dr. Smith's ECG Blog

DECEMBER 31, 2024

She presented to the Emergency Department at around 3.5 Soon after the witnessed occlusion, the patient suffered ventricular fibrillation arrest, from which he was immediately resuscitated with 1 defibrillation. The chest pain was described as severe pressure radiating to both shoulders. Vital signs were within normal limits.

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Coronary ACS STEMI CAD 118

FOAMfrat

NOVEMBER 25, 2024

Sure, we still do CPR, defibrillate as needed, and give Epinephrine based upon our local guidance. For patients suffering from intrapartum cardiac arrest, I would encourage you to transport the patient as expeditiously, but safely, as possible to the closest emergency department. We can all agree upon this.

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Epinephrine CPR Operating Room Plasma 105

Core EM

MARCH 5, 2025

One randomized control trial by showed that in patients with ventricular arrhythmias, an implantable cardioverter-defibrillator plus amiodarone may reduce sudden cardiac death and CHF exacerbations/hospitalizations when compared with amiodarone alone. The Western Journal of Emergency Medicine. Retrieved from [link] Gali, W.

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Defibrillator Blood Donation OR Emergency Department 130