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

Dr. Smith's ECG Blog

JULY 25, 2024

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% This patient was witnessed by bystanders to collapse. They started CPR. sodium bicarbonate.

Defibrillator 131

Defibrillator Coronary ACS Epinephrine 131

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

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. Bystander CPR is initiated prior to EMS arrival. EMS arrives on scene and initiates high quality basic life support (BLS).

BLS 130

BLS Defibrillator Critical Care CPR 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. 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.

Advanced Life Support 130

Advanced Life Support Life Support CPR Defibrillator 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.

Epinephrine 98

Epinephrine Defibrillator Coronary CPR 98

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 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 139

Defibrillator Coronary Epinephrine CPR 139

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. Weakness, prolonged PR interval, wide complex, ventricular tachycardia Very Wide and Very Fast, What is it?

Defibrillator 106

Defibrillator Epinephrine OR 106

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.

EMS 130

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.

CPR 130

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

Coronary 98

Coronary Life Support ALS Defibrillator 98

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 AEMT Defibrillator 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. References : 1.

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.

CPR 52

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

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 Defibrillator 52

EMS 12-Lead

MARCH 30, 2024

After administering 1mg of epinephrine ROSC is noted with a bradycardic rhythm ( Figure 2 ). As this case shows, electrical capture isn't always possible at lower currents, especially with pads placed in a standard anterolateral "defibrillation" position. Junctional Rhythm, occasional PAC's, and artifact.

CPR 312

CPR Paramedic Defibrillator Ambulance 312

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 ). What should you tell him?

CPR 130

CPR Defibrillator Firefighter Epinephrine 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?

Defibrillator 101

Defibrillator CPR Epinephrine Life Support 101

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. An ICD ( Implantable Cardioverter Defibrilator ) was placed prior to discharge. What do you think?

Defibrillator 137

Defibrillator Coronary ALS STEMI 137

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. Just prior to arrival he fell out of consciousness with the below ECG on the monitor.

Coronary 135

Coronary ACS Emergency Department Defibrillator 135

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

ECG Medical Training

DECEMBER 4, 2016

Let’s also not forget that these patients still require ventilation and they still require defibrillation! Start an IV and give epinephrine? Mechanical chest Compressions and simultaneous Defibrillation vs conventional Cardiopulmonary resuscitation in out-of-hospital cardiac arrest. The take-home message is this.

CPR 52

CPR E-9-1-1 Defibrillator ALS 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. The patient was intubated, given antiplatelet and antithrombotic therapy, 10 mEq of KCl IV was started, and sent to the cath lab.

STEMI 52

STEMI Plasma Defibrillator OR 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.

STEMI 52

STEMI Coronary ACS 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.

STEMI 52

STEMI Coronary ACS Emergency Department 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 CAD CPR 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 Defibrillator OR 40

ACEP Now

OCTOBER 28, 2024

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. EMS found the patient pulseless and apneic, with an initial rhythm showing ventricular fibrillation. Click here for the full article!

Emergency Department 52

Emergency Department Defibrillator Epinephrine ED 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.

STEMI 40

STEMI Defibrillator Epinephrine Emergency Department 40

Core EM

APRIL 23, 2025

Increasing use of mechanical CPR and ECMO has driven interest in novel defibrillation strategies. Background: Standard Defibrillation (Based on ACLS Guidelines) Indication: Primary intervention for pulseless VT/VF, the most common initial rhythm in witnessed cardiac arrest. Administer epinephrine every 35 minutes. N Engl J Med.

Defibrillator 130

Defibrillator CPR ALS Epinephrine 130

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). *

Epinephrine 216

Epinephrine Defibrillator Coronary ED 216

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 98

STEMI Paramedic E-9-1-1 Epinephrine 98

FOAMfrat

NOVEMBER 25, 2024

In the standard care of anaphylactoid reactions, we administer Epinephrine, Diphenhydramine, steroids, and bronchodilators. Sure, we still do CPR, defibrillate as needed, and give Epinephrine based upon our local guidance. Could this work for the AFE patient? The American Academy of Obstetrics and Gynecology isn’t sure.

Epinephrine 105

Epinephrine CPR Operating Room Plasma 105