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 129

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. But it’s not that straightforward.

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CPR ICU Critical Care Defibrillator 130

EMDocs

SEPTEMBER 14, 2024

Source Use of Glucagon-Like Peptide-1-Agonists and Increased Risk of Procedural Sedation and Endotracheal Intubation in the Emergency Department. Ann Emerg Med. Ann Emerg Med. 4: VF or VT – Earlier Defibrillation Is Better? We always work hard, but we may not have time to read through a bunch of journals.

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Defibrillator STEMI Emergency Department OR 71

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.

Defibrillator 52

Defibrillator CPR Coronary CAD 52

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. There are five steps in the AHA IHCA Chain of Survival: Sudden IHCA is a high stakes emergency with a high mortality rate.

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CPR Defibrillator ALS Emergency Response 100

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 94

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). What would your next steps be?

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Defibrillator CPR Epinephrine Life Support 85

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

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. Below (Figure A) I have marked the end of the QRS complexes by drawing a vertical line through the J-point of the standard and precordial leads.

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Coronary ACS Emergency Department Defibrillator 125

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. Jason Tanner, and an emergency department technician, Angel, assembled to treat this passenger.

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Defibrillator Emergency Department OR 52

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. So does this mean we cannot obtain a blood pressure? Is The LVAD Functioing? Pulse: It is often not palpable.

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CPR Defibrillator Emergency Department Emergency Transportation 64

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 72

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. Many paramedics are far better than any physician (Emergency or Cardiology) at diagnosing OM 3. V1 has 0.5 mm of elevation. ng/mL [IQR: 0.46, 2.35].

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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.

ACS 52

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. 2018 Sep 11;362:k3843. doi: 10.1136/bmj.k3843. N Engl J Med.

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

EMDocs

NOVEMBER 19, 2024

His roommate found an empty pill bottle on the floor next to him. Second-generation antipsychotics (see Table 1 below) improve both positive and negative symptoms of schizophrenia and are less likely to be associated with EPS. 1,2 Most second-generation antipsychotics act as D 2 antagonists and inhibit the 5-HT 2A receptor.

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Overdose EMS Emergency Medical Services OR 91

NCOAE

AUGUST 12, 2022

That’s because one of our areas of focus here at The National Center for Outdoor & Adventure Education (NCOAE) is emergency medicine training and education. The post Most EMS Terminology Comes Down to Initials, Abbreviations and Acronyms appeared first on National Center for Outdoor & Adventure Education.

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EMS EMT EMT Emergency Medical Technician 52

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. On arrival, vital signs are stable with a HR of 71, BP of 121/71 mmHg, RR of 17 bpm, and SpO2 of 97% on room air. Physical exam reveals a well-appearing female in no acute distress.

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E-9-1-1 EMS ALS Defibrillator 85

ECG Medical Training

JUNE 11, 2016

Additional Treatments Defibrillation pads were applied. The patient briefly considered refusing transport to the Emergency Department. A 12-lead ECG is obtained. There is a regular narrow complex tachycardia at a rate of 191. There are no visible P-waves. During the “strain phase” (A.) IV access was achieved.

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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. His family has been performing bystander, and report that he suddenly collapsed just a few minutes ago. mEq/L (OR: 51.11; 95% CI: 3.12−1639.16;

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

Broome Docs

JANUARY 30, 2023

Defibrillation Strategies for Refractory Ventricular Fibrillation. Am J Emerg Med. Association of Chest Pain Protocol-Discordant Discharge With Outcomes Among Emergency Department Patients With Modest Elevations of High-Sensitivity Troponin. Am J Emerg Med. N Engl J Med. 2022 Nov 6. doi: 10.1056/NEJMoa2207304.

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

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 74

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? Just another NSTEMI.

STEMI 52

STEMI ACS Coronary Defibrillator 52

NCOAE

MARCH 8, 2021

More specifically, you have three fundamental job responsibilities: Assessment and stabilization of the patient’s condition Basic life support Transportation In this post, we bring you up to speed on the different levels in emergency medicine and credentialing while explaining the basic education and skills required to become an EMT.

EMT 52

EMT EMT Emergency Medical Technician AEMT 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

Dr. Smith's ECG Blog

JANUARY 15, 2024

A patient in their 40s with type 1 diabetes mellitus and hyperlipidemia presented to the emergency department with 5 days of “flu-like” illness. They had difficulty describing their symptoms, but complained of severe weakness, nausea, vomiting, headache, and chest pain. They denied fever, cough, dyspnea, and sick contacts.

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Critical Care Defibrillator OR ALS 66

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?

ACS 52

ACS Coronary Defibrillator STEMI 52

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

NOVEMBER 7, 2023

A 67-year-old man presents to the emergency department (ED) in cardiac arrest. Multiple attempts at defibrillation, epinephrine, and amiodarone have been unsuccessful. Problem What is the best defibrillation strategy to treat refractory ventricular fibrillation? The primary outcome was survival to hospital discharge.

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Defibrillator E-9-1-1 ALS Epinephrine 52

REBEL EM

DECEMBER 19, 2022

Background Information: Double external defibrillation (DED) is an intervention often used to treat refractory ventricular fibrillation (RVF). This procedure involves applying another set of pads attached to a second defibrillator to a patient and shocking them in hopes of terminating the rhythm. N Engl J Med.

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Defibrillator Paramedic CPR EMS 52

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. Optivol TM , measures thoracic impedance through an ICD or CRT-D device. arrhythmia).

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Defibrillator Allergic Reaction ED ALS 87

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.

Emergency Department 52

Emergency Department Defibrillator Epinephrine EMS 52

Dr. Smith's ECG Blog

DECEMBER 31, 2024

She presented to the Emergency Department at around 3.5 Whether an ECG shows a pattern of OMI, SEI, both, or neither, the patient with ongoing ischemia needs to be considered for emergent reperfusion therapy. 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 112

FOAMfrat

NOVEMBER 25, 2024

Epidemiology Amniotic fluid embolism (AFE) is an incredibly rare yet catastrophic pathology during which fetal debris and/or amniotic fluid enters the maternal central circulation in the third trimester of pregnancy or, most commonly, during the labor process. Regardless, she complains of sudden and severe shortness of breath.

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Epinephrine CPR Operating Room Plasma 105

ACEP Now

OCTOBER 29, 2024

He was defibrillated twice and received two doses of epinephrine, with return of spontaneous circulation. Initial echocardiogram (ECG) on arrival (see figure 2) to our emergency department revealed normal sinus rhythm, mild interventricular conduction delay (RSR’), and possible right ventricular hypertrophy. Click to enlarge.)

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E-9-1-1 Defibrillator ALS Epinephrine 52