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 […] The post SGEM#314: OHCA – Should you Take ‘em on the Run Baby if you Don’t get ROSC? first appeared on The Skeptics Guide to Emergency Medicine.

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EMS Emergency Medical Services CPR Critical Care 130

Emergency Medicine Cases

JULY 3, 2018

In anticipation of EM Cases Episode 112 on Tachydysrhthmias with Amal Mattu and Paul Dorion, Melanie Baimel tells her Best Case Ever of a previously healthy young man who presents in refractory ventricular fibrillation after receiving multiple single shocks, ongoing chest compressions, several rounds of epinephrine, amiodarone and dual sequence defibrillation (..)

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Epinephrine Defibrillator EMS 130

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

The Skeptics' Guide to EM

OCTOBER 22, 2022

Case: You are the Chief of your local Fire and EMS Department, and an individual contacts you saying […] The post SGEM#380: OHCAs Happen and You’re Head Over Heels – Head Elevated During CPR? Head and thorax elevation during cardiopulmonary resuscitation using circulatory adjuncts is associated with improved survival.

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CPR Epinephrine Defibrillator Firefighter 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.

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CPR Defibrillator Advanced Life Support Emergency Medical Services 130

The Skeptics' Guide to EM

SEPTEMBER 29, 2018

Annals of EM May 2018 Guest Skeptic: Andrew Merelman is a critical care paramedic and first year medical student at Rocky Vista University in Colorado. Annals of EM May 2018 Guest Skeptic: Andrew Merelman is a critical care paramedic and first year medical student at Rocky Vista University in Colorado.

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ACEP Now

NOVEMBER 7, 2023

EMS physicians report he was found in ventricular fibrillation. Multiple attempts at defibrillation, epinephrine, and amiodarone have been unsuccessful. Problem What is the best defibrillation strategy to treat refractory ventricular fibrillation? He was found by bystanders after he collapsed and 911 was called.

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EMS 12-Lead

MARCH 30, 2024

As this case shows, electrical capture isn't always possible at lower currents, especially with pads placed in a standard anterolateral "defibrillation" position. Escalating directly to TCP requires a certain technical acumen to ensure its efficacy. The anterior-posterior position, however, was 80% more likely to gain capture.

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CPR Paramedic Ambulance Epinephrine 312

EMDocs

SEPTEMBER 23, 2023

We’ll keep it short, while you keep that EM brain sharp. 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. The post EM@3AM: Brugada Syndrome appeared first on emDOCs.net - Emergency Medicine Education.

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Emergency Medicine Cases

NOVEMBER 22, 2022

In this EM Quick Hits podcast: Justin Morgenstern on fluids in pancreatitis, Leeor Sommer on nasal fractures, Christina Shenvi on delirium, Sheldon Cheskes and Rohit Mohindra on Dose VF, and Noor Khatib and Kari Sampsel on intimate partner violence.

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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. The bottle contained 100 mg quetiapine tablets, and 50 tablets were unaccounted for. 1,2 Consider lidocaine if sodium bicarbonate fails. 1 Class IA (e.g.,

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Overdose EMS Emergency Medical Services OR 111

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

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

The Skeptics' Guide to EM

SEPTEMBER 23, 2017

Case: You are the medical director of an EMS system in a large city deciding on whether to respond to all out of hospital cardiac arrests (OHCA) with ACLS capabilities, or if resources should be directed to those candidates for extracorporeal CPR. 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

You are the first provider on scene with Emergency Medical Services (EMS) and start high-quality Cardiopulmonary Resuscitation (CPR). 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. He is unsuccessfully shocked.

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Epinephrine Life Support Advanced Life Support Defibrillator 130

EMT Training Station

FEBRUARY 11, 2024

In the realm of emergency healthcare, the terms EMS (Emergency Medical Services) and EMT (Emergency Medical Technician) are often used interchangeably, yet they represent distinct aspects of medical response and care. Though they are closely related and often work together, EMS and EMT have distinct roles, training, and responsibilities.

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EMT EMT Emergency Medical Technician Emergency Medical Services 98

The Skeptics' Guide to EM

MARCH 11, 2023

He is a former New York City paramedic and this summer will be starting fellowship training in EMS medicine at UNM. A fire company is on scene providing high-quality cardiopulmonary resuscitation (CPR) and has defibrillated twice with an automated external defibrillator (AED).

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CPR Defibrillator BLS Paramedic 130

ESO

DECEMBER 18, 2024

After reviewing over 12 million EMS incidents that took place in 2023 , the 2024 ESO EMS Index highlights two critical areas that demand attention: Early CPR and Opioid Use Disorder (OUD). Bystander CPR has been shown to double survival rates compared to cases where no CPR is performed prior to EMS arrival. Want to learn more?

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Naloxone CPR Overdose Defibrillator 52

Dr. Smith's ECG Blog

JULY 25, 2024

EMS arrived and found him in Ventricular Fibrillation (VF). 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.

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Defibrillator Coronary Epinephrine ACS 124

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 133

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

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Guest Skeptic: Dr. Stephen Meigher is the EM Chief Resident training with the Jacobi and Montefiore Emergency Medicine Residency Training Program. Guest Skeptic: Dr. Stephen Meigher is the EM Chief Resident training with the Jacobi and Montefiore Emergency Medicine Residency Training Program. The TOMAHAWK Investigators.

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EMR Coronary Defibrillator Life Support 130

EMDocs

JANUARY 16, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University in St. Louis); Dr. Jessica Pelletier, DO (EM Attending Physician, Washington University in St. You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Per EMS he was very cold to touch.

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Defibrillator CPR Epinephrine Life Support 109

Dr. Smith's ECG Blog

JANUARY 2, 2025

Dodd KW, Elm KD, Dodd EM, Smith SW. 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. New formula for evaluation of the QT interval in patients with left bundle branch block.

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Coronary OR Defibrillator ALS 116

Dr. Smith's ECG Blog

JUNE 13, 2024

EMS arrived to a pulseless patient in V fib. She was successfully defibrillated and taken back to the ED. They sued the the county-operated EMS service for allegedly not dispatching the call fast enough. They also sued both EMTs for allegedly not starting chest compressions and defibrillating quickly enough.

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Defibrillator STEMI EMT EMT 92

The Skeptics' Guide to EM

MARCH 2, 2019

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

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CPR Firefighter Paramedic Epinephrine 130

Dr. Smith's ECG Blog

JUNE 21, 2023

EMS was called, and they recorded the following ECG on scene at 13:16: What do you think? 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.

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STEMI Coronary Defibrillator EMS 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.

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Defibrillator Allergic Reaction ED ALS 113

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. He required multiple defibrillations within a period of a few hours. This time, the arrhythmia did not spontaneously terminate — but rather degenerated to VFib, requiring defibrillation.

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Defibrillator Coronary ALS STEMI 131

NCOAE

AUGUST 12, 2022

Today we’re taking a more serious look at language, this time highlighting the terminology used by members of the Emergency Medical Service (EMS) community. 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

The EMS Educator

NOVEMBER 20, 2021

EMS research should go hand-in-hand with our clinical training. 30, 2021, join your fellow EMS clinicians at the free 24-hour International Research Conference 2021: Global Developments in EMS Research. CE powered by Prodigy EMS. EMS research should go hand-in-hand with our clinical training.

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EMS 12-Lead

MARCH 19, 2023

Fire/EMS crews found him clammy and uncomfortable. Despite immediate chest compressions, and multiple rounds of defibrillation, he could not be resuscitated. Vital signs were noted to be unremarkable with respect to any hypo-hypertensive crisis, hypoxia, etc. Breath sounds were clear in all lung fields.

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Coronary STEMI Paramedic Defibrillator 130

REBEL EM

JUNE 1, 2023

Known cardiac defibrillator. appeared first on REBEL EM - Emergency Medicine Blog. Indication for emergency invasive coronary angiography or had coronary angiography within 1 hour of arrival. Known obstructive coronary artery disease or known coronary stent. Pre-existing DNR order. Severe renal dysfunction. Resus 2023.

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Coronary Defibrillator CPR ALS 145

The Skeptics' Guide to EM

DECEMBER 2, 2017

SGEM#64 : Classic EM Papers (OPALS Study) * SGEM#136 : CPR – Man or Machine? Cardiac Arrest: Pulselessness requiring chest compressions and/or defibrillation, with a hospital wide or unit based emergency response. Background: We have talked about out-of-hospital cardiac arrests (OHCA) many times on the SGEM.

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CPR Defibrillator ALS Emergency Response 100

Emergency Medicine Cases

MAY 23, 2017

This is the first ever video podcast on EM Cases with Jordan Chenkin from EMU Conference 2017 discussing how to optimize three aspects of cardiac arrest care: persistent ventricular fibrillation, optimizing pulse checks and PEA arrest, with code team videos contrasting the ACLS approach to an optimized approach.

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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. She denies chest pain.

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Defibrillator OR ED ALS 96

Dr. Smith's ECG Blog

SEPTEMBER 27, 2023

This was written by Magnus Nossen, from Norway, with comments and additions by Smith A 50 something smoker with no previous medical hx contacted EMS due to acute onset chest pain. Upon EMS arrival the patient appeared acutely ill and complained of chest pain. An ECG was recorded immediately and is shown below.

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Defibrillator OR Coronary EMS 133