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.

Defibrillator 52

Defibrillator CPR Life Support EMS 52

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. SGEM#64 : Classic EM Papers (OPALS Study) * SGEM#136 : CPR – Man or Machine?

CPR 130

CPR Defibrillator Advanced Life Support Emergency Medical Services 130

The Skeptics' Guide to EM

APRIL 27, 2024

This is because of the ease of finding anatomic landmarks and their location away from other procedures like defibrillation, CPR, and airway management. When emergency department (ED) staff roll her to remove her clothing her humeral intraosseous (IO) is dislodged. That episode was a study comparing intravenous (IV) vs IO access for OOHCAs.

ICU 185

ICU Defibrillator CPR Paramedic 185

The Skeptics' Guide to EM

OCTOBER 22, 2022

This includes epinephrine for OHCA, target temperature management, mechanical CPR, supraglottic airways, steroids, hands on defibrillation and many more topics. Background: We have covered Out of Hospital Cardiac Arrests (OHCAs) many, many times on the SGEM.

CPR 130

CPR Defibrillator Epinephrine Firefighter 130

The Skeptics' Guide to EM

SEPTEMBER 29, 2018

One defibrillation for ventricular fibrillation (VF) is provided but the patient remains in VF. We now know that an emphasis on the basics (high quality chest compressions and defibrillation) are the most important aspects of resuscitation. EMS arrives on scene and initiates high quality basic life support (BLS).

BLS 130

BLS Defibrillator Critical Care CPR 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 129

Defibrillator Coronary Epinephrine CPR 129

Dr. Smith's ECG Blog

JULY 25, 2024

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

Defibrillator 110

Defibrillator Coronary Epinephrine ACS 110

The Skeptics' Guide to EM

MARCH 11, 2023

A fire company is on scene providing high-quality cardiopulmonary resuscitation (CPR) and has defibrillated twice with an automated external defibrillator (AED). Case: A paramedic crew responds to a 54-year-old male in cardiac arrest at a private residence. Reference: Smida et al.

CPR 130

CPR Defibrillator BLS Paramedic 130

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. He is also the CME editor for Academic Emergency Medicine and the associate editor for emergency medicine simulation at the AAEM MedEdPORTAL.

Life Support 130

Life Support CPR Advanced Life Support Defibrillator 130

Medgadget

NOVEMBER 7, 2022

“All of the cells inside the heart get hit at one time, including the pain receptors, and that’s what makes pacing or defibrillation painful,” said Philipp Gutruf, a researcher involved in the study. With conventional pacemakers, the leads of the device are anchored into the wall of the heart, using invasive hooks or screws.

Defibrillator 103

Defibrillator OR 103

The Skeptics' Guide to EM

DECEMBER 7, 2018

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

Epinephrine 130

Epinephrine Life Support Advanced Life Support Defibrillator 130

St. Emlyn's

OCTOBER 21, 2024

St.Emlyn's - Emergency Medicine #FOAMed Should we use AP or AL pad position first for defibrillation in VF/VT cardiac arrest. Critical appraisal of an observational study in JAMA suggests a better outcome with AP, but there are many biases in this study. FOAMed @stemlyns The post AP or AL pad position for first choice shock in VF?

ALS 52

ALS OR Defibrillator 52

The Skeptics' Guide to EM

JULY 22, 2023

We should focus more on high-quality CPR and early defibrillation for shockable rhythms and less on type of supraglottic airway device. Your assessment is that the patient will likely be a physiologically, but not anatomically, difficult airway. Should you go with video or direct laryngoscope?

Emergency Medical Services 167

Emergency Medical Services Defibrillator CPR EMS 167

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. The K was normal.

Defibrillator 52

Defibrillator CPR Coronary CAD 52

Dr. Smith's ECG Blog

JUNE 9, 2024

We also gave insulin and furosemide (which take much longer to have their effect) After episodes of asystole and VF with defibrillation, she obtained ROSC and this 12-lead was recorded: The monitor around this time was NOT showing a very wide complex What do you think?

Defibrillator 103

Defibrillator Epinephrine OR 103

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. He reports feeling nauseated with emesis. There is ischemic ST depression in V4-V6.

Defibrillator 131

Defibrillator Coronary STEMI CPR 131

The Skeptics' Guide to EM

MARCH 2, 2019

Key to survival is high-quality CPR and early defibrillation. Background: We have covered OHCA many times on the SGEM. 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 ).

CPR 130

CPR Firefighter Paramedic Defibrillator 130

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Defibrillation is the treatment of choice in these cases but does not often result in sustained ROSC ( Kudenchuk et al 2006). She arrives in the emergency department (ED) with decreased level of consciousness and shock. The EKG shows sinus tachycardia with nonspecific changes and no ST segment elevations, Q waves, or hyperacute T waves.

EMR 130

EMR Coronary Defibrillator Life Support 130

The Skeptics' Guide to EM

JANUARY 9, 2021

OHCA was defined as persons found apneic and without a pulse who underwent either external defibrillation (bystanders or EMS) or chest compressions.

EMS 130

EMS Emergency Medical Services CPR Critical Care 130

EMDocs

OCTOBER 25, 2024

3: Does Defibrillator Pad Placement Matter for OHCA? Source Initial Defibrillator Pad Position and Outcomes for Shockable Out-of-Hospital Cardiac Arrest. We always work hard, but we may not have time to read through a bunch of journals. It’s time to learn smarter. West J Emerg Med. 2024;25(5):680-689. #3: JAMA Netw Open. 2024.31673.

Defibrillator 69

Defibrillator Emergency Department ALS OR 69

EMDocs

JUNE 29, 2024

Spoon Feed This secondary analysis of the DOSE VF trial found that DSED (dual sequence external defibrillation) was the superior strategy for obtaining ROSC and functional neurologic outcome regardless of whether the patient was in recurrent VF or shock-refractory VF after three standard defibrillation shocks. Resuscitation.

Defibrillator 70

Defibrillator Emergency Department ED OR 70

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. A healthy 45-year-old female presented with chest pain, with normal vitals. What do you think? There’s TWI in aVL but this is concordant to its QRS.

OR 70

OR STEMI ACS Coronary 70

EMDocs

JANUARY 8, 2024

With respect to timing, for cardiac arrest with a shockable rhythm, it may be reasonable to administer epinephrine after initial defibrillation attempts have failed. Consider administering epinephrine after defibrillation in those with shockable rhythms. COR 2b, LOE B-R. COR 2b, LOE B-R. COR 3, No benefit, LOE B-R. COR 2a, LOE B-NR.

Epinephrine 83

Epinephrine Defibrillator Coronary CPR 83

EMDocs

SEPTEMBER 14, 2024

4: VF or VT – Earlier Defibrillation Is Better? Source The impact of time to defibrillation on return of spontaneous circulation in out-of-hospital cardiac arrest patients with recurrent shockable rhythms. We always work hard, but we may not have time to read through a bunch of journals. It’s time to learn smarter. Ann Emerg Med.

Defibrillator 71

Defibrillator STEMI Emergency Department OR 71

The Skeptics' Guide to EM

JULY 3, 2021

Paramedics managed to get return of spontaneous circulation after a single defibrillation, but the patient is still comatose on arrival. When paramedics arrived, they found him to be in cardiac arrest, with ventricular fibrillation on the monitor. The charge nurse turns to you and asks: should I grab the ice packs? This gives a NNT of 4.

Paramedic 130

Paramedic Defibrillator ALS OR 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. A team member asks if you want to administer some sodium bicarbonate (1mEq/kg). Background: We often manage patients in cardiac arrest in the ED or the intensive care unit (ICU). But it’s not that straightforward.

CPR 130

CPR ICU Critical Care Defibrillator 130

Dr. Smith's ECG Blog

JULY 21, 2024

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. Some episodes of PMVT would terminate spontaneously — but on many occasions, the PMVT degenerated to VFib, requiring defibrillation.

Defibrillator 113

Defibrillator Coronary ALS STEMI 113

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? His point-of-care labs return with a potassium of 3.4

Defibrillator 85

Defibrillator CPR Epinephrine Life Support 85

REBEL EM

JUNE 1, 2023

Known cardiac defibrillator. Design: Prospective, observational, before and after implementation of a protocol study. Excluded: Obvious cause for OHCA prior to SDCT or on hospital arrival. Indication for emergency invasive coronary angiography or had coronary angiography within 1 hour of arrival. Pre-existing DNR order.

Coronary 145

Coronary Defibrillator CPR ALS 145

Dr. Smith's ECG Blog

JULY 14, 2023

He underwent further standard resuscitation EXCEPT that we applied the Inspiratory Threshold Device ( ResQPod ) AND applied Dual Sequential Defibrillation (this simply means we applied 2 sets of pads, had 2 defib machines, and defibrillated with both with only a fraction of one second separating each defibrillation.

E-9-1-1 85

E-9-1-1 Defibrillator CPR STEMI 85

The Skeptics' Guide to EM

DECEMBER 2, 2017

Cardiac Arrest: Pulselessness requiring chest compressions and/or defibrillation, with a hospital wide or unit based emergency response. He is currently deployed, practicing emergency medicine in an undisclosed location. DISCLAIMER: The views and opinions of this podcast do not represent the United States Government or the US Air Force.

CPR 100

CPR Defibrillator ALS Emergency Response 100

Dr. Smith's ECG Blog

JULY 14, 2010

She was defibrillated successfully from ventricular fibrillation and developed a perfusing rhythm. A 56 yo f with h/o HTN and hypercholesterolemia called EMS from home after onset of L chest pain radiating to the left arm. Before EMS arrived, she had "seizure activity" and became unresponsive. She was intubated.

OR 52

OR Defibrillator EMS 52

Dr. Smith's ECG Blog

JUNE 21, 2023

Two hours later , the patient returned to this same urgent care facility with worsening chest pain, and this ECG was performed: While getting another ECG, the patient suffered cardiac arrest: After multiple defibrillations, ROSC was achieved with ongoing "STEMI". In this case, the EMS provider was routed to the urgent care facility.

STEMI 95

STEMI Coronary Defibrillator EMS 95

EMS 12-Lead

MARCH 19, 2023

Despite immediate chest compressions, and multiple rounds of defibrillation, he could not be resuscitated. No appreciable skin pallor. He denied any known medical history, specifically: coronary artery disease, hypertension, dyslipidemia, diabetes, heart failure, myocardial infarction, or any prior PCI/stent.

Coronary 130

Coronary STEMI Paramedic Defibrillator 130

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. Urgent coronary angiography revealing mild coronary artery atherosclerosis and demonstrating angiographically normal right coronary artery anatomy. Click to enlarge.)

Coronary 98

Coronary Life Support ALS Emergency Department 98

Dr. Smith's ECG Blog

SEPTEMBER 27, 2023

After amiodarone and several defibrillations and about 20 minutes after initial arrest, stable ROSC was achieved. ECG#1 There is a regular tachycardia with a ventricular rate of about 180 bpm. Smith comment : When there is a regular wide complex tachycardia, first assess whether it is sinus or not. At a rate of 180, this is unlikely.

Defibrillator 128

Defibrillator OR Coronary EMS 128

Dr. Smith's ECG Blog

OCTOBER 18, 2023

She spontaneously converted (Defibrillation was not performed). Most such rhythms in the setting of ischemia are VF and will not convert without defibrillation. The above ECGs show the initiation and continuation of a polymorphic ventricular tachycardia. After about 90 seconds of chest compressions she awoke.

Defibrillator 105

Defibrillator Advanced Life Support Coronary Life Support 105