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.

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Emergency Medicine Cases

NOVEMBER 5, 2019

Sarah Reid on pediatric appendicitis risk calculator, Sheldon Cheskes & Mark Ramzy on double defibrillation for refractory ventricular fibrillation, Hans Rosenberg & Krishan Yadav on cellulitis clinical pearls, Anand Swaminathan on serratus anterior block, Brit Long on recognition of toxic shock syndrome, Justin Morgenstern on tranexamic acid (..)

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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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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. Unfortunately, most patients don’t receive these crucial interventions.

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Emergency Medical Services Defibrillator Advanced Life Support CPR 130

EMT First Aid

JANUARY 24, 2024

defibrillator is a lifesaving piece of medical equipment which delivers an electrical shock to a cardiac arrest victim. Research has shown that deploying a defibrillator What is an AED and how to use one.A Cardiac arrests can affect anyone at any time. 30,000 occur outside of hospitals across the UK each year.

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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.

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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. Moreover, when electrical signals are sent to the heart, every cell receives the shock, often leading to pain and discomfort.

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Medgadget

MAY 1, 2023

“One of the challenges for current pacemakers and defibrillators is that they are difficult to affix onto the surface of the heart,” said Igor Efimov, one of the creators of the new technology. “Defibrillator electrodes, for example, are essentially coils made of very thick wires.

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Defibrillator 111

SSCOR

DECEMBER 21, 2023

The elderly woman had gone into cardiac arrest just minutes before you arrived, but immediate CPR and rapid defibrillation were rewarded with a weak return of pulses. The call is going smoothly. Your IV is flowing and the patient is intubated.

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Defibrillator CPR EMS 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. The SGEM has also covered prehospital intubation using supraglottic devices for out-of-hospital cardiac arrests (OCHAs) with PA Missy Carter ( SGEM#247 and SGEM#396 ).

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Emergency Medical Services Defibrillator CPR EMS 245

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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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 C-LD. COR 3, No benefit, LOE B-R. COR 2b, LOE B-R. COR 2b, LOE C-LD.

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Epinephrine Defibrillator Coronary CPR 81

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

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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.

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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. Resuscitative attempts were initiated quickly. Eventually asystole, and the patient died.

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Defibrillator Coronary STEMI CPR 120

Utah's Paramedic and EMS Academy

OCTOBER 23, 2023

Upon arrival, you quickly assess the situation and spring into action, working to save a man's life through CPR and defibrillation. This includes checking monitors, defibrillators, airway management equipment, and other essential tools for stabilizing and transporting critically ill patients.

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EMT EMT Emergency Medical Technician Defibrillator 52

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. Case: A 46-year-old man has a cardiac arrest at home, witnessed by family.

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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.

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EMS 20/20

JULY 28, 2021

Sedation, Intubation, Ventilation, Defibrillation, Exasperation. Sedation, Intubation, Ventilation, Defibrillation, Exasperation. A Paramedic shoulders the weight of a hectic call. all the ations are present in this weeks absolutely epic episode! A Paramedic shoulders the weight of a hectic call.

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ACEP Now

JULY 7, 2023

Patients with a history of life-threatening or recurrent VT will often undergo radiofrequency catheter ablation and/or placement of a cardioverter defibrillator (implantable or external). Other treatments include electrical cardioversion and the use of antiarrhythmic drugs (e.g., amiodarone or lidocaine). See the original question here.)

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FOAMcast

JANUARY 24, 2023

This story is a reminder of the importance of continuous chest compressions, early defibrillation, and that what we do in emergency and prehospital medicine matters. Billy Frolick , a writer and our patient that day shares his perspective on his case with us.

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Defibrillator Emergency Department OR 52

EMS 20/20

OCTOBER 20, 2021

Can a patients implanted defibrillator shock you? Can a patients implanted defibrillator shock you? Can our hosts offer up some sage advice without making too many Star Trek references? Listen and find out! A patient with a OW troubling and painOWful experience is treated by a OW crew OW that may be jumping to conclusions.

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Defibrillator 40

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).

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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 are five steps in the Chain-of-Survival for OHCA: Most of us can agree with the first three steps. You need to recognize an arrest and activate your EMS system.

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Life Support Advanced Life Support CPR Defibrillator 130

Broome Docs

OCTOBER 31, 2022

PMID: 35490863 Hands on defibrillation: Even if it’s safe, would it actually help? Ex vivo evaluation of personal protective equipment in hands-on defibrillation. PMID: 35942482 earing gloves, hands on defibrillation is probably safe. Stephens AF, Šeman M, Nehme Z, Voskoboinik A, Smith K, Gregory SD, Stub D. Resusc Plus.

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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

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. Pediatric defibrillation doses should be 2j/kg, 4j/kg. Speaking of protocol changes, Connecticut released its latest two year update. mg via syringe.* micrograms/kg/min. 6j/kg and 8j/kg.

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CPR Naloxone Advanced Life Support EMT 52

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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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). Background: The American Heart Association estimates there are approximately 350,000 EMS-assessed out-of-hospital cardiac arrests (OHCAs) in the United States per year.

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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". The LCX was noted to be "subtotally stenosed" at the time of cath.

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Prehospital Emergency Care Podcast

JANUARY 1, 2020

To be more specific, "AVAILABILITY AND USE OF AN AUTOMATED EXTERNAL DEFIBRILLATOR AT EMERGENCY MEDICAL DISPATCH." The PEC podcast team has been working hard over the past month to bring in 2020 with new research and new partnerships (stay tuned for that!) Let's ring in the new year for where it all begins in EMS. Dispatch.

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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? 2,3 Multiple published studies have addressed treatment of ventricular fibrillation with defibrillation and medications such as amiodarone and lidocaine.

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Defibrillator E-9-1-1 ALS Epinephrine 52

The EMS Educator

NOVEMBER 20, 2021

You'll earn CE credit and hear topics such as monitoring the gazes of novice medics during defibrillation, suicidality and compassion fatigue, how we should evaluate claims on social media, TXA and whole blood for trauma, and more. These are new ideas, on the cutting edge of science, and not yet in textbooks.

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K.S. Chew

MAY 25, 2019

This is a potentially fatal mistake because for VF, the one intervention besides CPR that is proven to increase survival to hospital discharge is defibrillation (but not for PEA). Unable to recognize ventricular fibrillation or ventricular tachycardia There are some students who cannot differentiate VF from PEA.

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EMS 12-Lead

MARCH 19, 2023

Despite immediate chest compressions, and multiple rounds of defibrillation, he could not be resuscitated. Anyone who has worked emergency medicine for any length of time immediately recognizes this statement as a cry for help and equally portends dire change. He became unconscious as the monitor displayed VF.

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Coronary STEMI Paramedic Defibrillator 130

The Skeptics' Guide to EM

MARCH 2, 2019

Key to survival is high-quality CPR and early defibrillation. After the patient is stabilized the medic asks you how he can improve his airway management skills during a cardiac arrest as it was difficult to intubate during compressions. What should you tell him? Background: We have covered OHCA many times on the SGEM.

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CPR Firefighter Paramedic Defibrillator 130

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.

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