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.

BLS 130

BLS Defibrillator Critical Care CPR 130

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. After 1 mg of epinephrine they achieved ROSC. Total prehospital meds were epinephrine 1 mg x 3, amiodarone 300 mg and 100 mL of 8.4% They started CPR.

Defibrillator 124

Defibrillator Coronary Epinephrine ACS 124

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. vs. 66.8%, p=0.73).

CPR 130

CPR Life Support Advanced Life Support Defibrillator 130

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. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S.

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

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.

Defibrillator 133

Defibrillator Coronary Epinephrine CPR 133

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?

CPR 130

CPR Firefighter Paramedic Epinephrine 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.

Defibrillator 109

Defibrillator CPR Epinephrine Life Support 109

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. Epinephrine infusion was begun. He required multiple defibrillations within a period of a few hours. An ICD ( Implantable Cardioverter Defibrilator ) was placed prior to discharge.

Defibrillator 131

Defibrillator Coronary ALS STEMI 131

Peter Canning

JANUARY 14, 2024

For all the fancy changes over the year, the bottom line has always been to provide good CPR compressions and timely defibrillation. The pediatric epinephrine and norepinephrine infusion rates have been lowered to 0.1-0.5 The pediatric epinephrine and norepinephrine infusion rates have been lowered to 0.1-0.5 mg via syringe.*

CPR 52

CPR Naloxone EMT EMT 52

REBEL EM

SEPTEMBER 19, 2022

Background: There are only two interventions that have been proven in the medical literature to improved outcomes in cardiac arrest: high-quality CPR and early defibrillation. Population: Patients > 18 years of age w/ OHCA treated by 10 EMS systems in in the US. Head Up (HUP) CPR may be the next critical improvement.

CPR 52

CPR Defibrillator EMS Epinephrine 52

ECG Medical Training

DECEMBER 4, 2016

Alongside tracheal intubation , response times , and fire-based EMS, this is one of the most controversial topics in prehospital medicine. This is important because too many EMS systems look at mechanical CPR as a way to avoid having to become experts in resuscitation or having to send additional resources to the scene.

CPR 52

CPR E-9-1-1 Defibrillator Ambulance 52

Dr. Smith's ECG Blog

APRIL 29, 2020

EMS arrived and found her in a wide complex PEA rhythm. She was given 3 mg IV epinephrine and multiple rounds of ACLS over approximately 20 minutes. She was never defibrillated. This is commonly found after epinephrine for cardiac arrest, but could have been pre-existing and a possible contributing factor to cardiac arrest.

Epinephrine 52

Epinephrine Defibrillator Coronary Overdose 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.

E-9-1-1 52

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

Dr. Smith's ECG Blog

OCTOBER 10, 2022

It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation. The morphology of V2-V4 is very specific in my experience for acute right heart strain (which has many potential etiologies, but none more common and important in EM than acute pulmonary embolism). On epinephrine and norepinephrine drips."

ACS 52

ACS CPR CAD Heart Attack 52

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.

Defibrillator 52

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.

Defibrillator 52

Defibrillator Paramedic CPR EMS 52

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. Chest compressions were continued, and the patient was given 1 round of epinephrine, calcium, bicarb, glucose.

Defibrillator 52

Defibrillator ICU EMS Plasma 52

ACEP Now

OCTOBER 28, 2024

EMS found the patient pulseless and apneic, with an initial rhythm showing ventricular fibrillation. He was defibrillated twice and received 2 doses of epinephrine, with return of spontaneous circulation. There was no family history of syncope or sudden death. Click here for the full article!

Emergency Department 52

Emergency Department Epinephrine Defibrillator EMS 52

Dr. Smith's ECG Blog

DECEMBER 22, 2010

After epinephrine, atropine, and defibrillation x 2, there was a return of pulses. Annals of EM 23(6):1333-1342; June 1994. A 65 yo woman had felt ill for 36 hours, had seen her MD but without undergoing a cardiac evaluation. She collapsed and 911 was called; she was found pulseless. Exact rhythm during arrest is uncertain.

STEMI 40

STEMI Epinephrine Defibrillator Emergency Department 40

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

Resuscitated with chest compressions, epinephrine. including epinephrine, and there was ROSC. Smith makes the key point that had this arrest witnessed by the medic team been the result of an acute cardiac event ( therefore, presumably VT or VFib ) prompt defibrillation by on-the-scene medics would most probably have resuscitated her.

STEMI 89

STEMI Paramedic E-9-1-1 Epinephrine 89

FOAMfrat

NOVEMBER 25, 2024

Earlier in the summer, I wrote a blog discussing the challenges, intricacies, and educational pitfalls of postpartum hemorrhage in EMS. In the standard care of anaphylactoid reactions, we administer Epinephrine, Diphenhydramine, steroids, and bronchodilators. I even know of cases that my colleagues have managed!

Epinephrine 105

Epinephrine CPR Operating Room Plasma 105

ACEP Now

OCTOBER 29, 2024

EMS found the patient pulseless and apneic, with an initial rhythm showing ventricular fibrillation (see figure 1). He was defibrillated twice and received two doses of epinephrine, with return of spontaneous circulation. Figure 1: The EMS rhythm strip. There was no family history of syncope or sudden death.

E-9-1-1 52

E-9-1-1 Defibrillator ALS Epinephrine 52