Dr. Smith's ECG Blog

SEPTEMBER 16, 2024

After resuscitation and defibrillation , there were no more episodes of TdP. Below is the patient’s 12 lead ECG following defibrillation. Events in Panel B — suggest a different clinical situation. This is pause - dependent QTc prolongation (which is described as the most common cause of TdP in patients with LQTS ).

Defibrillator 67

Defibrillator Coronary OR ALS 67

Dr. Smith's ECG Blog

JANUARY 23, 2023

Back to the case: After the patient was roomed, he revealed that he had undergone several episodes of syncope in the last 24 hours with each event resulting in a shock during which his wife reported that he would immediately awaken. The most recent event had occurred just before being triaged.

ACS 52

ACS Coronary Defibrillator STEMI 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. Calcium Chloride Is Given to Sicker Patients During Cardiopulmonary Resuscitation Events. Sanchez, G., Venkataraman, P.,

E-9-1-1 52

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

Dr. Smith's ECG Blog

OCTOBER 3, 2017

Side note: contemporary troponin drawn 1 hour after acute LAD occlusion should usually be negative, unless the event has been going on longer than the patients symptoms. After the second defibrillation the patient had an organized rhythm: Bradycardic escape/agonal rhythm, with large ST deviations.

CPR 52

CPR Defibrillator STEMI ED 52

EMT Training Station

FEBRUARY 11, 2024

Flame Burns These are secondary burns caused when an electrical event ignites clothing or nearby materials. We use portable electrocardiogram (ECG) machines to monitor heart rhythms and are equipped to administer life-saving interventions like defibrillation or medication administration to stabilize the heart rhythm.

EMT 98

EMT EMT Emergency Medical Technician First Aid 98

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

But because Dr. Mastoras recognized the hyperacute T waves, the patient was immediately seen, the polymorphic VT was immediately defibrillated, and the patient was rapidly diagnosed and treated. Without clinical context, the Queen of Hearts identified OMI with high confidence, based on the hyperacute waves.

OR 65

OR STEMI ACS Coronary 65

Dr. Smith's ECG Blog

OCTOBER 26, 2020

12 minutes later, the patient went back into VFib arrest and underwent another 15 minutes of resuscitation followed by successful defibrillation and sustained ROSC. In total, he received approximately 40 minutes of CPR and 7 defibrillation attempts. EMS found the patient in VFib and performed ACLS for 26 minutes then obtained ROSC.

Coronary 40

Coronary Defibrillator ACS CAD 40

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

She was defibrillated and resuscitated. Takotsubo is a sudden event, not one with crescendo angina. Even in patients whose moderate stenosis undergoes thrombosis, most angiograms show greater than 50% stenosis after the event. It is apparently fortunate that she had a cardiac arrest; otherwise, her ECG would have been ignored.

Emergency Department 52

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

Dr. Smith's ECG Blog

FEBRUARY 13, 2023

This clinical presentation alone immediately places this patient in a " high -prevalence" group for having an acute event even before you look at the ECG! There was 100% proximal LAD occlusion, EF was 55% with severe hypokinesis to mid-distal septum and apex.

STEMI 52

STEMI Paramedic Coronary ALS 52

High Performance EMS

OCTOBER 11, 2024

October is Sudden Cardiac Arrest Awareness month, so High Performance EMS and PulsePoint are encouraging everyone to locate and register Automated External Defibrillators (AEDs). Participating public safety agencies recommend more than 1,000 nearby AEDs for approximately 800 cardiac arrest events every day!

Public Safety 317

Public Safety Defibrillator EMD CPR 317

Paramedic Training Spot

NOVEMBER 29, 2021

AED stands for Automatic External Defibrillator , which is a machine that measures the rhythm of a person’s heart and can deliver electric current if necessary. Knowing the current events of our country and world is important to be a well-rounded person, as you never know what useless bit of information may come in handy on a call.

EMT 52

EMT EMT Paramedic Ambulance 52

Dr. Smith's ECG Blog

JUNE 27, 2024

A patient had a cardiac arrest with ventricular fibrillation and was successfully defibrillated. IF the initial ECG following successful defibrillation shows evidence of acute OMI — such patients have much to gain from immediate cath with PCI. As per Dr. Smith — the intuitive answer should be obvious.

Defibrillator 112

Defibrillator STEMI Coronary ALS 112

Paramedics Unlimited

APRIL 19, 2018

Paramedics can also provide full cardiac monitoring and interpretation, including cardiac defibrillation, as well as advanced airway management, including endotracheal intubation and cricotomy. In Advanced Life support (ALS) emergencies, a “single” paramedic or ER doctor can not deliver necessary care.

BLS 52

BLS ALS Emergency Medical Technician Advanced Life Support 52

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

VF was refractory to amiodarone, lidocaine, double-sequential defibrillation, esmolol, etc. Then the patient would have been taken to the critical care area with a defibrillator at his side while waiting for the cath lab to be ready. But I'd be less certain about an acute event without more information and prior and/or serial tracings.

Defibrillator 134

Defibrillator Coronary STEMI CPR 134

EMT Training Station

FEBRUARY 10, 2024

Some find themselves in the middle of major events like concerts or sports games, ready to act if needed. They learn to operate sophisticated life-saving tools, from defibrillators to advanced airway management devices. EMTs also have the best uniforms from boots to pants , as an EMT you get to lookgood while doing good.

EMT 98

EMT EMT Emergency Medical Technician First Responder 98

ECG Medical Training

DECEMBER 4, 2016

Let me preface this by saying that these are my opinions which are based on my review of the medical literature and my real life experiences using mechanical CPR at the system level, including post-event analysis of resuscitations in which mechanical CPR was used. The take-home message is this. The Lancet. 2015;385(9972):947–955. 2013.282538.

CPR 52

CPR E-9-1-1 Defibrillator Ambulance 52

Don't Forget the Bubbles

JULY 26, 2023

Some families have unexplained deaths during sporting events, an unusual number of car accidents, seizures in someone without a formal diagnosis of epilepsy. A full examination is necessary but can be completely normal following the event. If we look at some London-based data: Palpitations – A cause for concern?

ALS 98

ALS ED OR CPR 98

EMDocs

SEPTEMBER 23, 2023

In patients with Brugada syndrome who have survived a life-threatening arrhythmic event, long-term use of quinidine has been shown to decrease recurrent arrhythmic events 12. The only proven therapy is an ICD.

E-9-1-1 105

E-9-1-1 EMS ALS Defibrillator 105

Dr. Smith's ECG Blog

JANUARY 30, 2019

In light of the risk of arrhythmia events observed in the Mizusawa trial, a formal EP study might be reasonable to obtain in those with fever induced asymptomatic Brugada ECG changes to help risk stratify these patients. Pediatric and elderly patients were more predisposed to developing an arrhythmic event in the setting of fever [7].

E-9-1-1 52

E-9-1-1 CAD STEMI OR 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

As an aside, the LCx OMI is a type 2 event, since it is due to supply-demand mismatch from thrombus, and not due to atherosclerotic plaque rupture or erosion). Rhythm C: This telemetry strip from an older adult was initially thought to need defibrillation. This resulted in anterior/apical infarct and apical thrombus formation.

Critical Care 63

Critical Care Defibrillator OR ALS 63

Dr. Smith's ECG Blog

SEPTEMBER 20, 2018

One must always be careful when looking for "baseline" ECGs, because the prior ECG on file may have been during another ACS event, as this one clearly was. He was defibrillated immediately and had return of normal mental status. Cath lab activation was cancelled but the transfer was accepted for urgent cardiology evaluation.

STEMI 52

STEMI Coronary ACS Defibrillator 52

ECG & Echo Learning

JANUARY 18, 2023

I B ECG monitoring should start immediately and a defibrillator must be ready. IIa B In STEMI patients with stent implantation and an indication for oral anticoagulation, triple therapyd should be considered for 1–6 months (according to a balance between the estimated risk of recurrent coronary events and bleeding).

STEMI 40

STEMI Coronary OR Defibrillator 40

Dr. Smith's ECG Blog

DECEMBER 5, 2019

If there are any syncopal or presyncopal events, she should be evaluated immediately in the ED. --All This article is on Brugada in general, not just fever-induced: A score model to predict risk of events in patients with Brugada Syndrome Here is full text: [link] This was a single center cohort of 400 patients with Brugada syndrome.

ALS 52

ALS OR Defibrillator STEMI 52

Dr. Smith's ECG Blog

DECEMBER 20, 2024

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. CRT-P is cardiac resynchronization therapy with pacing only, without the ability to defibrillate. Specifically, it overlies a thicker radiopaque segment.

Defibrillator 101

Defibrillator Coronary ALS Emergency Department 101

Dr. Smith's ECG Blog

MARCH 25, 2025

In this case, you should get a second defibrillator and perform double sequential external defibrillation (DSED). Simply attach a second defibrillator as shown in the diagram below and deliver max shocks from both devices simultaneously. In the second case, the patient never converted meaning the shock did not do its job at all.

Defibrillator 62

Defibrillator ACS Coronary ALS 62

Dr. Smith's ECG Blog

NOVEMBER 29, 2024

Throughout this process, the patient had repeated VF and was defibrillated 8 times. This patient had been seen 5 days earlier at another hospital where she underwent aspiration thrombectomy for an acute event. Prolonged thrombectomy effort was unsuccessful. Post PCI angiogram is shown below.

Defibrillator 65

Defibrillator STEMI Coronary ED 65

Dr. Smith's ECG Blog

FEBRUARY 2, 2025

Defibrillation was performed, and ROSC was achieved. As a result without yet looking at the initial ECG, our "mindset" has-to-be awareness that this history alone places this patient in a higher risk category for having an acute cardiac event. Unfortunately, the ECG was interpreted as no significant change from prior , "no STEMI"!!

STEMI 85

STEMI Defibrillator ACS OR 85

Dr. Smith's ECG Blog

DECEMBER 27, 2024

The submitter started the patient on amiodarone and arranged implantation of a defibrillator. == MY Comment , by K EN G RAUER, MD ( 12/27 /2024 ): == Superb discussion by Dr. Frick in today's case, that highlights a series of important points regarding the ECG recognition of stable VT ( V entricular T achycardia ).

Coronary 120

Coronary Defibrillator ACS ED 120

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

Here is the written paramedic report available after all the events were over: Patient was seen by witnesses to become unresponsive. PEA is uncommon as an initial rhythm witnessed by EMS on the scene when the cause is an acute ischemic event. Mistaking such cases as an acute cardiac event is not uncommon because of these ECG changes.

STEMI 88

STEMI Paramedic E-9-1-1 Epinephrine 88

Dr. Smith's ECG Blog

MARCH 8, 2025

Several 200 J shocks did not terminate the VF, so a second defibrillator was applied for double sequential defibrillation with 400 J. She was defibrillated perhaps 25 times. Propranolol versus Metoprolol for treatment of electrical storm in patients with implantable cardioverter-defibrillator. SanzRuiz, R., Solis, J., &

E-9-1-1 74

E-9-1-1 OR Defibrillator Coronary 74

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. Click to enlarge.)

E-9-1-1 52

E-9-1-1 Defibrillator ALS Epinephrine 52