The Skeptics' Guide to EM

SEPTEMBER 29, 2018

One defibrillation for ventricular fibrillation (VF) is provided but the patient remains in VF. As part of their protocol, they attempt vascular access to administer epinephrine and an antidysrhythmic. EMS arrives on scene and initiates high quality basic life support (BLS). Patients were also excluded if incarcerated or pregnant.

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BLS Defibrillator Critical Care CPR 130

EMDocs

JANUARY 8, 2024

Vasopressor medications during cardiac arrest We recommend that epinephrine be administered for patients in cardiac arrest. It is reasonable to administer epinephrine 1 mg every 3 to 5 minutes for cardiac arrest. High-dose epinephrine is not recommended for routine use in cardiac arrest. COR 1, LOE B-R. COR 2a, LOE B-R.

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Epinephrine Defibrillator Coronary CPR 98

The Skeptics' Guide to EM

SEPTEMBER 23, 2017

Bystander high-quality CPR can buy you some time until defibrillation. We know that rapid application of electricity to defibrillate shockable arrhythmias save lives. There have been a number of papers published since OPALS that support the findings of not using ACLS drugs like epinephrine for OHCA: * Olavseengen et al.

Life Support 130

Life Support CPR Advanced Life Support Defibrillator 130

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. Here is the initial ED ECG.

Defibrillator 133

Defibrillator Coronary Epinephrine CPR 133

Dr. Smith's ECG Blog

JUNE 9, 2024

Over the next 10 minutes we resuscitated with high doses of Calcium, Epinephrine, and Bicarbonate. There was no IV access, so we obtained intraosseous (IO) access, but she arrested before we could give her all the calcium.

Defibrillator 101

Defibrillator Epinephrine OR 101

The Skeptics' Guide to EM

MARCH 2, 2019

Key to survival is high-quality CPR and early defibrillation. There is no evidence for a patient-oriented benefit with epinephrine ( SGEM#238 ), other ACLS drugs ( SGEM#64 ), pre-hospital therapeutic hypothermia ( SGEM#54 , SGEM#183 ), or mechanical CPR ( SGEM#136 ). Background: We have covered OHCA many times on the SGEM.

CPR 130

CPR Firefighter Paramedic Defibrillator 130

The Skeptics' Guide to EM

JANUARY 9, 2021

This has included things like therapeutic hypothermia ( SGEM#54 , SGEM#82 , SGEM#183 and SGEM#275 ), supraglottic devices ( SGEM#247 ), crowd sourcing CPR ( SGEM#143 and SGEM#306 ), and epinephrine ( SGEM#238 ). One aspect we have not looked at is the “load and go” vs. “stay and play” approach for OHCA.

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EMS Emergency Medical Services CPR Critical Care 130

The Skeptics' Guide to EM

FEBRUARY 25, 2023

Apart from high-quality CPR and early defibrillation, many other interventions we try lack a strong evidence base. 1] The SGEM has covered the use of epinephrine, vasopressin, methylprednisolone, and calcium for cardiac arrest in SGEM#238 , SGEM#350 , and SGEM#353. . * But it’s not that straightforward.

CPR 130

CPR ICU Critical Care Defibrillator 130

EMDocs

JANUARY 16, 2024

The patient received 1 mg of epinephrine IV x2 with conversion of his rhythm to ventricular fibrillation (VF) for which he was defibrillated twice in the field. The patient is moved over to the stretcher and connected to the monitors and defibrillator. What would your next steps be?

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Defibrillator CPR Epinephrine Life Support 106

Dr. Smith's ECG Blog

JULY 21, 2024

Epinephrine infusion was begun. 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. You can see Left Main and Proximal LAD obstruction, but with some flow, which is saving this patient's life.

Defibrillator 131

Defibrillator Coronary ALS STEMI 131

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. Traditional Advanced Cardiovascular Life Support (ACLS) medications, namely epinephrine, have been known to exacerbate coronary vasospasm. Click to enlarge.)

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Coronary Life Support ALS Emergency Department 98

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The arrhythmia spontaneously converted before defibrillation was achieved. The patient was administered thrombolytics and shortly after the lytics were administered, the systolic blood pressure rose to about 80mmHg with ongoing epinephrine infusion. This ECG has widespread ST depression and an almost "Aslanger-like" appearance.

Coronary 129

Coronary ACS Emergency Department Defibrillator 129

Dr. Smith's ECG Blog

OCTOBER 4, 2010

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

ACS 52

ACS Defibrillator Epinephrine STEMI 52

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

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. Fine ventricular fibrillation She received 2 mg epinephrine, 150 mg amiodarone and underwent chest compressions with the LUCAS device. at the time of the ECG. See image with lines below).

Defibrillator 52

Defibrillator ACS CPR STEMI 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. Over the years, we as a scientific community have worked extensively to find other interventions that improve outcomes. Impedance threshold device application.

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CPR Defibrillator EMS Epinephrine 52

Dr. Smith's ECG Blog

APRIL 29, 2020

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. EMS arrived and found her in a wide complex PEA rhythm.

Defibrillator 52

Defibrillator Epinephrine Coronary Overdose 52

ECG Medical Training

DECEMBER 4, 2016

Let’s also not forget that these patients still require ventilation and they still require defibrillation! We use the LUCAS device, and there are other devices out there like the AutoPulse or the Thumper. I understand that others may have different opinions about mechanical CPR, and that’s fine with me. ” Two points here.

CPR 52

CPR E-9-1-1 Defibrillator Ambulance 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. 1639.16; p=0.01).

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

Dr. Smith's ECG Blog

JUNE 19, 2023

The patient is started on epinephrine infusion for cardiogenic shock and cardiology took the patient to the cath lab. During angiogram in the cath lab, the patient suffered two episodes of ventricular fibrillation for which he was successfully defibrillated. Here is his triage ECG which was obtained at 20:34 during active pain.

STEMI 52

STEMI ACS Coronary Defibrillator 52

Dr. Smith's ECG Blog

OCTOBER 20, 2013

With ventilations and epinephrine, she regained a pulse. She was never seen to be in ventricular fibrillation and was never defibrillated. A middle-age woman with h/o hypertension was found down by her husband. Medics found her apneic and pulseless, began CPR, and she was found to be in asystole. BP gradually rose. Kurkciyan et al.

STEMI 52

STEMI Coronary ACS Emergency Department 52

Dr. Smith's ECG Blog

APRIL 8, 2016

At cath, he immediately had incessant Torsades de Pointes requiring defibrillation 7 times and requiring placement of a transvenous pacer for overdrive pacing at a rate of 80. Here is his ED ECG: There is obvious infero-posterior STEMI. What are you worried about in addition to his STEMI? There is also bradycardia.

STEMI 52

STEMI Plasma Defibrillator OR 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation. On epinephrine and norepinephrine drips." He reportedly told his family "I think I'm having a heart attack", then they immediately drove him to the ED, and he was able to ambulate into the triage area before he collapsed and became unresponsive.

ACS 52

ACS CPR CAD Heart Attack 52

ECG & Echo Learning

JANUARY 18, 2023

I B ECG monitoring should start immediately and a defibrillator must be ready. This page summarises the most current recommendations for the management of acute coronary syndromes with persistent ST-segment elevations (i.e STEMI , ST-segment elevation acute myocardial infarction ). due to reciprocal ST-segment depressions in V1, V2, V3).

STEMI 40

STEMI Coronary OR Defibrillator 40

ACEP Now

NOVEMBER 7, 2023

Multiple attempts at defibrillation, epinephrine, and amiodarone have been unsuccessful. Problem What is the best defibrillation strategy to treat refractory ventricular fibrillation? 7 In attempts to improve survival of this devastating condition, investigators have reported alternative defibrillation techniques.

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

He was defibrillated twice and received 2 doses of epinephrine, with return of spontaneous circulation. The patients’ mother has attempted to flush the SPC multiple times unsuccessfully at home. The catheter was reportedly due for an exchange the following week. There was no family history of syncope or sudden death.

Emergency Department 52

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. 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. What was the inciting factor?

STEMI 40

STEMI Defibrillator Epinephrine Emergency Department 40

Critical Care Scenarios

JANUARY 8, 2025

Takeaway lessons * In any sudden loss of pulse/consciousness, particularly in a known cardiac patient, the presumption should be for a shockable arrhythmia and rapid defibrillation should be prioritized above all else. If you’re above this DBP, just skip epinephrine, which will probably merely be toxic (ie promoting arrhythmias). *

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Epinephrine Defibrillator Coronary ED 212

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

Resuscitated with chest compressions, epinephrine. including epinephrine, and there was ROSC. This is what the providers in the ED understood on patient arrival: Patient called 911 for syncope, then had witnessed PEA arrest after medics arrived. Not a shockable rhythm. They laid her on the floor and called 911.

STEMI 88

STEMI Paramedic E-9-1-1 Epinephrine 88

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. He underwent placement of a dual chamber, implantable, cardioverter-defibrillator (ICD) placement on hospital day 5. There was no family history of syncope or sudden death. Figure 1: The EMS rhythm strip.

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E-9-1-1 Defibrillator ALS Epinephrine 52