Podcasts about defibrillation

Recorded live at the Critical Care Canada Forum 2024, this episode is part of our special Cardiac ICU Series.Dr. Rebecca Mathew, cardiologist and critical care specialist at the University of Ottawa Heart Institute, joins us to discuss the latest refractory cardiac arrest practice updates, including antiarrhythmic drugs, defibrillation strategies, and the role of ECPR.Chapters: • Defining refractory cardiac arrest • Antiarrhythmic drugs: amiodarone vs. lidocaine • Defibrillation strategies: vector change and double sequential defibrillation • Emerging therapies: stellate ganglion blocks and electrical storm management • ECPR: who qualifies and what the trials say • Equity and feasibility challenges in cardiac arrest management • ICU recovery clinics and patient-centered outcomes • Clinical trials: barriers to enrollment and the need for changeReferences: 1. ROC ALPS Trial: 1. Kudenchuk PJ, Brown SP, Daya M, et al. Resuscitation Outcomes Consortium-Amiodarone, Lidocaine or Placebo Study (ROC-ALPS): Rationale and Methodology Behind an Out-of-Hospital Cardiac Arrest Antiarrhythmic Drug Trial. American Heart Journal. 2014;167(5):653-9.e4. doi:10.1016/j.ahj.2014.02.010. PMID: 24766974.[1] 2. DOSE VF: Cheskes S, Drennan IR, Turner L, Pandit SV, Dorian P. The Impact of Alternate Defibrillation Strategies on Shock-Refractory and Recurrent Ventricular Fibrillation: A Secondary Analysis of the DOSE VF Cluster Randomized Controlled Trial. Resuscitation. 2024;198:110186. doi:10.1016/j.resuscitation.2024.110186. PMID: 38522736 3. ARREST: Yannopoulos D, Bartos J, Raveendran G, et al. Advanced Reperfusion Strategies for Patients With Out-of-Hospital Cardiac Arrest and Refractory Ventricular Fibrillation (ARREST): A Phase 2, Single Centre, Open-Label, Randomised Controlled Trial. Lancet (London, England). 2020;396(10265):1807-1816. doi:10.1016/S0140-6736(20)32338-2. PMID: 33197396 4. INCEPTION: Ubben JFH, Suverein MM, Delnoij TSR, et al. Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest - A Pre-Planned Per-Protocol Analysis of the INCEPTION-trial. Resuscitation. 2024;194:110033. doi:10.1016/j.resuscitation.2023.110033. PMID: 37923112 Disclaimer:This episode is for educational purposes only and does not constitute medical advice. The views expressed are those of the hosts and guests and do not necessarily reflect their employers.

Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous, high-quality CPR and early defibrillation. The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation. The chance of successful defibrillation decreases every minute that passes. How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't. Why bystander CPR is important for out-of-hospital cardiac arrest (OHCA) outcomes. The role of the CPR coach. Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!

Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people.Defibrillators can be broken down into three basic categories: 1. Automated External Defibrillator (AED);2. Biphasic defibrillators; and3. Monophasic defibrillators.Use of an AED to rapidly deliver a shock. Advantages & use of Biphasic defibrillators.For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach.AEDs must not be used on patients with a pulse.Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators. Team safety when performing synchronized cardioversion. Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia. Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!

Unlock the potential to save lives with our exciting discussion on the Anesthesia Patient Safety Foundation's Technology Education Initiative course. Featuring Dr. Michael Kazior, an esteemed anesthesiologist and intensivist, we spotlight the crucial skills of manual external defibrillation, cardioversion, and pacing. Dr. Kazior shares his personal journey and highlights the stark educational gaps in defibrillator usage among anesthesia professionals. This course, born from the collaboration between the APSF and the American Society of Anesthesiologists, promises an interactive learning experience that aims to bolster confidence and competence in using these vital life-saving devices. Additionally, this course is a robust addition to the APSF's suite of courses, including those on low-flow anesthesia and quantitative neuromuscular monitoring, all designed to equip anesthesia professionals with comprehensive knowledge of essential technologies.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/239-enhancing-defibrillation-skills-the-apsfs-technology-education-initiative/© 2025, The Anesthesia Patient Safety Foundation

Scientists at Durham University have developed a theoretical framework to predict the efficacy of quenching of electrical pulses in excitable media, such as those found in the human heart. This breakthrough could significantly accelerate the development of more efficient defibrillation techniques for treating cardiac arrhythmias. Quenching electrical waves in the heart The study, published in Physical Review E, addresses a longstanding challenge in understanding how stable excitation waves in systems like cardiac tissue can be effectively neutralised through small changes. These electrical waves, when irregular, are thought to underly serious conditions such as fibrillation, where the heart fails to pump blood effectively. The research provides a way to predict the smallest possible interventions required to restore the system to a stable resting state and permit the normal rhythm to reassert itself. The study bridges a crucial gap in understanding how to disrupt harmful excitation waves with minimal energy input, especially in the earliest stages of defibrillation through direct intervention. Lead researcher Dr Christopher Marcotte of Durham University's Department of Computer Science said: "Predicting how small changes to carefully tuned states develop over time underlies much of our understanding of complex phenomena, from turbulence to weather; similar predictions for dynamically robust states, like fully developed electrical waves in the heart, requires further insight into the larger structures of these systems and how they interact. "By predicting the boundaries for efficacious interventions in the propagation of these electrical waves, we provide additional tools for defibrillation researchers." The team developed a linear theory capable of predicting 'quenching perturbations' - small changes that return an unstable system to its resting state. This method improves upon traditional brute-force approaches by using computationally efficient semi-analytical techniques, inspired by similar approaches developed for the ignition - or starting excitation - of these waves. This research focus on predicting suppression offers fresh insights into how to halt erratic electrical activity in tissues. Using this framework, the researchers tested their predictions against various mathematical models of excitable media, including those simulating cardiac electrical activity. The theory proved highly effective, showing qualitative and, in many cases, quantitative agreement with direct numerical simulations. Defibrillation, the medical procedure to restore normal heart rhythms, typically involves applying a strong electrical shock to disrupt fibrillation. This study opens the door to refining these techniques by targeting specific regions of the heart with smaller, more precise electrical pulses. This could lower energy requirements, reducing the risk of tissue damage and making treatments more patient-friendly. However, the researchers caution that quenching excitation waves is inherently more energy-intensive than initiating them as the latter rely on stored chemical energy in the tissue, which presents challenges for direct practical implementation. Despite these challenges, the research findings lay the groundwork for innovations in low-energy defibrillation strategies and may augment emerging techniques like the Low-Energy Atrial Pacing (LEAP) method. To encourage further exploration, the researchers have made their methodology and data openly available online. By providing access to their code, they hope to foster collaboration and spur additional advances in this critical area of medical science. Source Predicting effective quenching of stable pulses in slow-fast excitable media', (2024), Christopher Marcotte, Physical Review E. An embargoed copy of the paper is available from Durham University Communications Office. Please email communications.team@durham.ac. uk. About Durham University Durham University is a globally outstan...

[Ep54] You're listening to Episode 27 of 30 ... for National Podcast Post Month! Aka - NaPodPoMo.This episode's featured topic is an expansion on my thoughts about why using Zoll training equipment with Laerdal 3G manikins is a bummer. About National Podcast Post MonthThe event gives everyone in the podcast community a chance to challenge their skills by posting an episode every day for the entire month of November! So that's what High-Fidelity Conversations will be doing. In order to keep my sanity, the episodes will be shorter (a few minutes), and the topics will be all over the place (still healthcare-themed). Each of the episodes associated with this event will be marked with "NaPodPoMo" somewhere in the title, so you know when all this chaos starts and ends. I hope you enjoy this adventure for November! We'll be back to our normal, monthly pattern for December.Do you have ideas for future guests or topics on this podcast? Maybe you have some thoughts on how to improve the show? If that sounds like you, take a moment to answer the 3 questions on our anonymous feedback survey!Podcast artwork was made with the awesome resources from CanvaMusic and Sound FX for the show obtained from Pixabay and Pond5Email the show at hfconversations@gmail.comClosed Captioning Resources:Podnews article (for Apple/Android phones and Google Chrome browsers)Microsoft Windows article (live captions for Windows users)Apple article (live captions for Mac users)Disclaimer:The thoughts and opinions expressed in this podcast belong solely to those saying them, and do NOT represent the positions, strategies or opinions of Trinity Health, or Mount Carmel Health System. This podcast is intended for educational and entertainment purposes only. Nothing in this podcast establishes a patient care relationship with you, the listener. The host(s) and guests of this show are NOT your healthcare provider and if you need medical attention, seek an appropriate and qualified professional. 

Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous, high-quality CPR and early defibrillation. The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation. The chance of successful defibrillation decreases every minute that passes. How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't.Why bystander CPR is important for out-of-hospital cardiac arrest (OHCA) outcomes. The role of the CPR coach. Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of 80% or more.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!

Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories: 1. Automated External Defibrillator (AED);2. Biphasic defibrillators; and3. Monophasic defibrillators.Use of an AED to rapidly deliver a shock. Advantages & use of Biphasic defibrillators. For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach. AEDs must not be used on patients with a pulse. Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators. Team safety when performing synchronized cardioversion. Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia. Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!

Defibrillation in my circulation? Hotwire my heart!

Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous, high-quality CPR and early defibrillation. The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation (VF).The chance of successful defibrillation decreases every minute that passes. How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't. Why bystander CPR is important for out-of-hospital cardiac arrest (OHCA) outcomes. The role of the CPR coach.Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!

Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories: 1. Automated External Defibrillator (AED);2. Biphasic defibrillators; and3. Monophasic defibrillators. Use of an AED to rapidly deliver a shock. Advantages & use of Biphasic defibrillators. For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach.AEDs must not be used on patients with a pulse.Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators.Team safety when performing synchronized cardioversion. Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia. Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!

Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous, high-quality CPR and early defibrillation. The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation. The chance of successful defibrillation decreases every minute that passes. How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't.Why bystander CPR is important for out-of-hospital cardiac arrest (OHCA) outcomes. The role of the CPR coach.Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back - buy Paul a bubble tea hereGood luck with your ACLS class!

Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories:1. Automated External Defibrillator (AED);2. Biphasic defibrillators; and3. Monophasic defibrillators.Use of an AED to rapidly deliver a shock.Advantages & use of Biphasic defibrillators. For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach.AEDs must not be used on patients with a pulse. Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators. Team safety when performing synchronized cardioversion. Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia. Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back - buy Paul a bubble tea hereGood luck with your ACLS class!

Dr Tony Smith, Deputy Clinical Director at Hato Hone St John, tells us about Double Sequential and Vector Change Defibrillation for resistant VF/VT.  These new techniques, not currently covered in our NZRC resus algorithms, are being utilised by all ambulance services in New Zealand for patients who do not get ROSC after three shocks.   Tony can be contacted for questions at - Tony.Smith@stjohn.org.nz    Check out the paper mentioned Cheskes S, Verbeek PR, Drennan IR, McLeod SL, Turner L, Pinto R, Feldman M, Davis M, Vaillancourt C, Morrison LJ, Dorian P, Scales DC. Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. 2022 Nov 24;387(21):1947-1956. doi: 10.1056/NEJMoa2207304. Epub 2022 Nov 6. PMID: 36342151. https://www.nejm.org/doi/full/10.1056/NEJMoa2207304  And the editorial - https://www.nejm.org/doi/full/10.1056/NEJMe2213562    Check out the Article from the Conversation - https://theconversation.com/a-new-emergency-procedure-for-cardiac-arrests-aims-to-save-more-lives-heres-how-it-works-221979    Check out the article from the NZMJ Dicker B, Maessen S, Swain A, Garcia E, Smith T. Are two shocks better than one? Aotearoa New Zealand emergency medical services implement a new defibrillation strategy: implications for around nine patients per week. N Z Med J. 2024 Mar 22;137(1592):105-107. doi: 10.26635/6965.6429. PMID: 38513209.      www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by Score Squad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice always consult your usual doctor 

EMRA*Cast host Dustin Slagle, MD, and NYU critical care cardiology fellow James Ciancarelli, DO, revisit the topic of a prior episode – dual synchronous defibrillation – to further explore the theory, logistics, evidence, and indications for its use.

Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous, high-quality CPR and early defibrillation. The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation. The chance of successful defibrillation decreases every minute that passes. How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't. Why bystander CPR is important for out-of-hospital cardiac arrest (OHCA) outcomes. The role of the CPR coach. Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back - buy Paul a bubble tea hereGood luck with your ACLS class!

Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories:1. Automated External Defibrillator (AED);2. Biphasic defibrillators; and3. Monophasic defibrillators.Use of an AED to rapidly deliver a shock. Advantages & use of Biphasic defibrillators. For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach. AEDs must not be used on patients with a pulse. Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators. Team safety when performing synchronized cardioversion. Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia. Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back - buy Paul a bubble tea hereGood luck with your ACLS class!

Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous, high-quality CPR and early defibrillation. The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation. The chance of successful defibrillation decreases every minute that passes. How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't. Why bystander CPR is important for out-of-hospital cardiac arrest (OHCA) outcomes. The role of the CPR coach. Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%. Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!

Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories: Automated External Defibrillator (AED);Biphasic defibrillators; andMonophasic defibrillators.Use of an AED to rapidly deliver a shock. Advantages & use of Biphasic defibrillators.For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach.AEDs must not be used on patients with a pulse. Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators. Team safety when performing synchronized cardioversion. Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia.Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!

THA #70 - 911, Help Me: A Cardiac Survivor's Tale of Dispatchers and Defibrillation Service to our country in the US NAVY and graduate level studies in business earned Rob Hoadley the titles of Veteran & Master of Business Administration.  A dedicated husband and father, Rob is drawn to serve our cause because he is the Survivor of multiple Sudden Cardiac Arrests (5x in 2011, 2x in 2018, and 16 ICD shocks in 2021…23 Total!). This has earned him the title of… Survivor. Rob currently helps place Life Saving AEDs wherever they are needed. Using his valuable knowledge and experience in the world of Sudden Cardiac Arrest, Rob is an accomplished Keynote and Public Speaker and Advocate for SCA awareness, AEDs, and CPR. Delivering a message of resilience, strength, vulnerability, and yes…Survival, Rob has motivated and inspired countless people. Rob is a member of an International Advisory Group and Public Research Collaborative working to develop and validate a new Patient Reported Outcome Measure for Sudden Cardiac Arrest survivors, including their families and/or caregivers. This collaborative has published the first of its anticipated bodies of work. As a member of the Sudden Cardiac Arrest Foundation Advisory Council, Rob will bring all of his earned “titles” to the table to focus his passion on helping save more lives from SCA.  More specifically, Rob will help SCAF assist fellow survivors in the sixth link in our Chain of Survival, Recovery. Rob is happily married to his beautiful and strong wife Dori. He is also the proud father of two beautiful and equally strong young women, Kristin and Laurin Hoadley.” 

Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous high quality CPR and early defibrillation. The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation. The chance of successful defibrillation decreases every minute that passes. How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't. Examples of in-hospital and out-of-hospital cardiac arrest (OHCA) outcomes when CPR is performed until defibrillation vs defibrillation without CPR. The role of the CPR coach. Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!

Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories: 1. Automated External Defibrillator (AED);2. Biphasic defibrillators; and3. Monophasic defibrillators. Because AEDs are designed to be used by first responders, and lay people with only minimal medical training, the controls are kept simple and are pre-programmed into the machine. Use of an AED to rapidly deliver a shock. Biphasic defibrillators automatically measure the impedance between the defib pads and will adjust the energy to deliver the shock needed based on the patient. Biphasic defibrillator use and energy setting. For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach. AEDs must not be used on patients with a pulse. Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators. Team safety when performing synchronized cardioversion. Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia. Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!

Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference are continuous high quality CPR and early defibrillation. The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation. The chance of successful defibrillation decreases every minute that passes. How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't. Examples of in-hospital and out-of-hospital cardiac arrest (OHCA) outcomes when CPR is performed until defibrillation vs defibrillation without CPR. The role of the CPR coach. Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%. Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!If you're looking for other medical podcasts and online CE, check out ConveyMED.io

Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories:1. Automated External Defibrillator (AED);2. Biphasic defibrillators; and3. Monophasic defibrillators.Because AEDs are designed to be used by first responders, and lay people with only minimal medical training, the controls are kept simple and are pre-programmed into the machine.Use of an AED to rapidly deliver a shock. Biphasic defibrillators automatically measure the impedance between the defib pads and will adjust the energy to deliver the shock needed based on the patient. Biphasic defibrillator use and energy setting. For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach. AEDs must not be used on patients with a pulse. Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators. Team safety when performing synchronized cardioversion. Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia. Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!

Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous high quality CPR and early defibrillation.The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation.The chance of successful defibrillation decreases every minute that passes. How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't.Examples of in-hospital and out-of-hospital cardiac arrest (OHCA) outcomes when CPR is performed until defibrillation vs defibrillation without CPR. The role of the CPR coach.Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!

Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories:1. Automated External Defibrillator (AED);2. Biphasic defibrillators; and3. Monophasic defibrillators.Because AEDs are designed to be used by first responders, and lay people with only minimal medical training, the controls are kept simple and are pre-programmed into the machine.Use of an AED to rapidly deliver a shock.Biphasic defibrillators automatically measure the impedance between the defib pads and will adjust the energy to deliver the shock needed based on the patient.Biphasic defibrillator use and energy setting.For monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach.AEDs must not be used on patients with a pulse.Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators. Team safety when performing synchronized cardioversion.Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia.Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!

japp, auch uns ist es jetzt passiert und dabei waren wir so im flow... bis wir dann gemerkt haben, dass die Aufnahme nicht wollte... jetzt halt von vorn... Viel Medizincontent dabei: Defibrillation bei Säuglingen, ACE und die Nephroprotektion nach Kontrastmittelexposition bei Nierenkrankheit, Nanobots und was war doch gleich ein primärer, sekundärer und tertiärer Krankheitsgewinn? Ein Medikament ist auch in dieser Folge dabei und natürlich gibt es den Lifehack für Bambies - also eigentlich mal wieder mehrere, weil Timo nicht aufhören konnte zu reden! Warum gibt es eigentlich keine emails mehr von euch? Bitte hört nicht auf damit - info@mtma.tv Wenn ihr uns unterstützen wollt, dann schaut bitte mal bei Patreon vorbei.

Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories:1. Automated External Defibrillator (AED);2. Biphasic defibrillators; and3. Monophasic defibrillators.Because AEDs are designed to be used by first responders, and lay people with only minimal medical training, the controls are kept simple and are pre-programmed into the machine. Use of an AED to rapidly deliver a shock.Biphasic defibrillators automatically measure the impedance between the defib pads and will adjust the energy to deliver the shock needed based on the patient. Biphasic defibrillator use and energy setting.For older, monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach. AEDs must not be used on patients with a pulse. Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators. Team safety when performing synchronized cardioversion.Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia. Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!

Link to NEJM studyLink to MCFRS CPG

Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous high quality CPR and early defibrillation. The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation. The chance of successful defibrillation decreases every minute that passes. How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't. Examples of in-hospital and out-of-hospital cardiac arrest (OHCA) outcomes when CPR is performed until defibrillation vs defibrillation without CPR. The role of the CPR coach.Three tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!

Welcome to Episode #369 of the 303 Endurance Podcast. We're your hosts Coach Rich Soares and 303 Chief Editor, Bill Plock. Thanks for joining us for another week of endurance interviews and discussion.   Show Sponsor: UCAN Generation UCAN has a full line of nutrition products powered by LIVESTEADY to fuel your sport.   LIVSTEADY (formerly SuperStarch) was purposefully designed to work with your body, not against it, delivering long-lasting energy you can feel. LIVSTEADY is different. Its unique time-release profile allows your body to access energy consistently throughout the day, unlocking your natural ability to stay focused and calm while providing the fuel you need to meet your daily challenges.   Use UCAN in your training and racing to fuel the healthy way, finish stronger and recover more quickly!  Use the code 303UCAN for 20% off at ucan.co/discount/303UCAN/ or ucan.co   In Today's Show Endurance News Sudden Cardiac Arrest on National TV: An Explainer and What it Means for Triathletes IRONMAN Announces Nice, France as the 2nd IMWC Location A 2023 Buyer's Guide to America's Best Bicycle Insurance What's new in the 303 Upcoming Interview   News Sponsor Buddy Insurance: Buddy Insurance gives you peace of mind to enjoy your training and racing to the fullest. Buddy's mission is simple, to help people fearlessly enjoy an active and outdoor lifestyle.    Get on-demand accident insurance just in case the unexpected happens. Buddy ensures you have cash for bills fast.  Go to buddyinsurance.com and create an account.  There's no commitment or charge to create one.  Once you have an account created, it's a snap to open your phone and in a couple clicks have coverage for the day.  Check it out!   Endurance News:   Sudden Cardiac Arrest on National TV: An Explainer and What it Means for Triathletes Tragic events at a recent NFL football game has athletes of all kinds asking: Are we at risk? JANUARY 4, 2023 JEFFREY SANKOFF    Last night much of the American television viewing public was taking in Monday Night Football to see a big game with playoff implications. The Buffalo Bills were visiting the Cincinnati Bengals when, after a fairly routine play, 24-year-old safety Damar Hamlin unexpectedly collapsed to the ground. The game announcers initially thought that Hamlin had simply been injured on the play, but very quickly it became apparent that something far more serious was going on.   Hamlin, it turns out, was in cardiac arrest. Once the training staff realized what was happening began to administer cardiopulmonary resuscitation (CPR). He was resuscitated again upon arriving at the University of Cincinnati Medical Center's intensive care unit, where he remains in critical condition.   At this point, I think that is helpful to dispel confusion about some common terms that are frequently thrown around the media in these situations. Doing so now will allow for a much clearer description of what happened to this player, and help unpack whether this incident should be a cause for concern for endurance athletes who are all too familiar with the specter of sudden cardiac death (SCD) in our own sports.   RELATED: Do Triathletes Need to Worry About Heart Attacks?   Heart Attack vs. Cardiac Arrest The first thing that needs to be made clear is the difference between a heart attack and cardiac arrest. A heart attack occurs when there is a blockage in one of the arteries that carries blood to the tissue of the heart. The heart muscle is exquisitely sensitive to dips in oxygen-rich blood flow, so if a coronary artery becomes obstructed, the cells that are being fed by that artery do not receive oxygen—they become injured and quickly die. In medical terminology this is called a myocardial infarction. In the spring of 2021, professional triathlete Tim O'Donnell experienced a heart attack while competing in a race. Fortunately, he did not suffer cardiac arrest.   Cardiac arrest, on the other hand, occurs when the heart ceases pumping blood forward to the brain and the rest of the body. There are many causes for cardiac arrest and one of the more common ones is a heart attack. However, while cardiac arrest is frequently caused by heart attacks, only a small percentage of heart attacks cause cardiac arrest. During cardiac arrest, the heart can come to a standstill in which case all electrical activity ceases. This is known as asystole, and is typically represented in popular culture or on TV as a “flat line” on a cardiac monitor. More commonly, the initial electrical rhythm in cardiac arrest is either ventricular tachycardia—in which the ventricles of the heart are being stimulated to beat so fast that they do not have an adequate amount of time to fill with blood and therefor the pumping action does not result in any blood flow—or, ventricular fibrillation, in which the electrical activity in the heart is chaotic and disorganized and the muscle just quivers and no pumping occurs at all.   Whatever the underlying rhythm, during cardiac arrest there is no blood flow to the brain and it is imperative that two things happen as quickly as possible: CPR must be initiated and if indicated, cardiac defibrillation must be done. CPR is the application of chest compressions to the victim and is how some forward blood flow can be re-established until such time as the heart's normal electrical activity can be restarted. Cardiac defibrillation is the application of an electrical shock to the heart. In the setting of either ventricular tachycardia or ventricular fibrillation, this shock works to depolarize the entire heart muscle and resets the electrical system. That brief moment of pause is then hopefully when the heart's normal pace making activity can kick in and a normal rhythm can resume. Defibrillation does not work for asystole, so all those times you see characters on television or movies attempting to shock a patient who has a flat line shown on a cardiac monitor, that is just not going to work!   Are endurance athletes at risk? As I mentioned earlier, SCD is a very real issue for endurance athletes, and Damar Hamlin's incident rightly heightens awareness once again on the potential tragic consequences of training for and racing in our sport or any other where we put our hearts under stress. I have spoken on my podcast on more than one occasion about this subject as well, but the situation that Hamlin experienced last night needs to be clearly distinguished from those which triathletes and other endurance athletes face.   CC is a very specific and rare event that is specifically related to a blunt force trauma to the chest directly overlying the heart. Triathletes, on the other hand (as well as other endurance athletes who develop dysrhythmias or SCD) typically experience heart conditions related to structural problems from years of high-volume and high-intensity training or because of the development over time of atherosclerotic coronary artery disease that in many cases is silent.   There is unfortunately little in the way that can be done to screen athletes for these problems because as horrifying as SCD is, it remains a fortunately rare event and no screening has been shown to effectively and reliably identify those who are at risk. Instead, it remains the athletes' responsibility especially as they age to be diligent about paying attention to their body and being attentive to any signs or symptoms that could be attributable to an underlying cause.   Palpitations, shortness of breath at lower than expected amounts of exertion or any kind of chest pain with exertion should be signals to an athlete to cease training and seek immediate medical evaluation before returning to training. While commotio cordis is simply not likely to be an issue for triathletes, SCD remains a very real—if thankfully rare—event. While the cause may be different, an outcome similar to what Damar Hamlin experienced is still a possibility, one that we would all like to avoid at all costs.     IRONMAN Announces Nice, France as the 2nd IMWC Location TAMPA, Fla./NICE, Fra. (Jan. 5, 2022) – Following the previous announcement of the IRONMAN® World Championship continuing its commitment to dedicated race days for men and women, it was announced today that Nice, France will become the location for the 2023 men's edition as co-host of the VinFast IRONMAN World Championship.   The race will take place on September 10, 2023, adding to the history of the European birthplace for long-distance triathlon. As previously confirmed, the women will race on October 14, 2023 in Kailua-Kona, Hawai`i. In 2024, the men will rotate to Kona racing, on October 26, 2024, while the women will rotate to Nice and race on September 22, 2024. The rotation will continue through 2026 with Nice and Kona acting as co-hosts for the pinnacle event in triathlon.   Acknowledging the importance of continuing a dedicated IRONMAN World Championship event for both women and men, IRONMAN quickly identified Nice, France amongst other world-renowned candidates as a familiar and historically important triathlon destination to join as a dual host for the event. The city has all the attributes to provide the backdrop for an exceptional world championship experience.   “In 2022, we saw the power of a two-day IRONMAN World Championship, one with dedicated race days for professional women and professional men. We believe in this concept not only to showcase the depth of both the women's and men's fields but also to invest further into the growth of the sport of triathlon. Nice, France, as the European birthplace of long-course triathlon is the right place to showcase this evolution,” said Andrew Messick, President & Chief Executive Officer for The IRONMAN Group. “We are grateful to Mayor Estrosi and the City of Nice, who share our vision of creating a world-class championship race for the men in 2023, and then the women in 2024.”     A 2023 Buyer's Guide to America's Best Bicycle Insurance With the right bike insurance, a cyclist can protect their bicycle or eBike, while riding or in transit, bike accessories, and theft of the bicycle with optional theft protection. January 4, 2023 / ENDURANCE SPORTSWIRE – BikeInsure, an insurtech company specializing in bicycle accident coverage for cyclists in the United States, has released a 2023 Buyer's Guide to America's Best Bike Insurance. Today's cyclists need a standalone insurance policy to protect their new or used bicycles and eBikes. BikeInsure provides damage reimbursement for repairs to your bike and listed accessories due to riding accidents. And during transit. The BikeInsure plan extends to a stolen bike or eBike when optional theft protection is selected.   Standalone Bicycle Insurance refers to a separate bike insurance policy that covers specific risks not covered by your existing policies. For example, the Forbes Magazine article “Do you Need Bike Insurance for Your Bicycle?” addressed Bicycle Damage, “You crash your bike. If you crash into an object like a tree or car, you typically won't be covered under a home, condo, or render insurance policy for the bike damage.” The BikeInsure standalone insurance plan will not compromise a cyclist's homeowner's insurance if a bicycle accident claim occurs.   “Unlike the few traditional bike insurance companies in the United States, BikeInsure has Standardized Bike Insurance, a simple 2-minute sign-up comprehensive insurance for bicycles,” said Buzzy Cohn, CEO of BikeInsure. BikeInsure innovated a process that allows a cyclist to obtain bike coverage with optional theft protection for a bicycle as quickly as it was to get for your smartphone, all from the BikeInsure website. In addition, the comprehensive insurance for your bike or eBike includes a standardized $10,000 limit and a $100 deductible for only $16.99 monthly.   “While cycling is safe, accidents do happen,” said Ira Becker, President of BikeInsure. “Now available to cyclists across America is standalone bike insurance that is standardized with real value and reasonably priced coverage. BikeInsure is the solution for bicycle insurance.”   Closing: Thanks again for listening in this week.  Please be sure to follow us @303endurance and of course go to iTunes and give us a rating and a comment.  We'd really appreciate it! Stay tuned, train informed, and enjoy the endurance journey!

In this episode, we discuss the recently published DOSE VF trial, which evaluated the efficacy of early double sequential defibrillation strategy over vector change and standard defibrillation strategies. This trial has demonstrated that this innovative strategy has the potential to improve mortality and is likely to change our practices.

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. At REBEL EM, we've done an extensive write up that details some of ... Read more The post REBEL Cast Ep113: Defibrillation Strategies for Refractory Ventricular Fibrillation appeared first on REBEL EM - Emergency Medicine Blog.

In this episode, we review the largest trial of double sequential external defibrillation (DSED) and vector change (VC) defibrillation for refractory ventricular fibrillation (VFib): Cheskes S, Verbeek PR, Drennan IR, et al. Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. 2022;387(21):1947-1956. Show notes, references, & infographics: FOAMcast.org Thanks for listening! Jeremy Faust & Lauren Westafer

Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories:1. Automated External Defibrillator (AED);2. Biphasic defibrillators; and3. Monophasic defibrillators.Because AEDs are designed to be used by first responders, and lay people with only minimal medical training, the controls are kept simple and are pre-programmed into the machine.Use of an AED to rapidly deliver a shock.Biphasic defibrillators automatically measure the impedance between the defib pads and will adjust the energy to deliver the shock needed based on the patient.Biphasic defibrillator use and energy setting.For older, monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach.AEDs must not be used on patients with a pulse.Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators.Team safety when performing synchronized cardioversion.Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia.Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGood luck with your ACLS class!

Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous high quality CPR and early defibrillation. The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation. The chance of successful defibrillation decreases every minute that passes. How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't.Examples of in-hospital and out-of-hospital cardiac arrest (OHCA) outcomes when CPR is performed until defibrillation vs defibrillation without CPR. The role of the CPR coach.Three tips to aid us in limiting CPR interruptions so we can maintain a chest compression fraction (CCF) of at least 80%.Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGood luck with your ACLS class!

Dr. Prajwal Deshmukh on atrial defibrillation, or AFIB

Remembering all the different energy setting needed for synchronized cardioversion and defibrillation used to be confusing for a lot of people. Defibrillators can be broken down into three basic categories: Automated External Defibrillator (AED); Biphasic defibrillators; and Monophasic defibrillators. Because AEDs are designed to be used by first responders, and lay people with only minimal medical training, the controls are kept simple and are pre-programmed into the machine. Use of an AED to rapidly deliver a shock. Biphasic defibrillators automatically measure the impedance between the defib pads and will adjust the energy to deliver the shock needed based on the patient. Biphasic defibrillator use and energy setting. For older, monophasic defibrillators, use 360J to defibrillate V-Fib or pulseless V-Tach. AEDs must not be used on patients with a pulse. Cardioversion of patients in unstable SVT or V-Tach with a pulse using biphasic vs monophasic monitor/defibrillators. Team safety when performing synchronized cardioversion. Energy needed to cardiovert unstable patients with a narrow vs wide complex tachycardia. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website:  https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!

Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous high quality CPR and early defibrillation. The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation. The chance of successful defibrillation decreases every minute that passes.  How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't. Examples of in-hospital and out-of-hospital cardiac arrest (OHCA) outcomes when CPR is performed until defibrillation vs defibrillation without CPR. The role of the CPR coach. Three tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%. Feedback on the show, suggestions for episodes, and donations are appreciated. **American Cancer Society (ACS) Fundraiser This is the fourth year that I'm participating in Real Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission. I hope you'll consider contributing. Every donation makes a difference in the fight against breast cancer! http://main.acsevents.org/goto/paultaylor (Paul Taylor's ACS Fundraiser) THANK YOU! Connect with me: Website:  https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!

Remembering the different suggested energy settings for cardioversion and defibrillation when using different models or types of defibrillators has been made easier with biphasic & AED technology. AEDs are preprogrammed with a set energy setting to maximize the effectiveness of defibrillation. Biphasic defibrillators measure the impedance between the pads and will calculate the suggested energy for us. For monophasic defibrillators, set the energy at 360j and leave it. Cardioversion is similar when using a biphasic defibrillator; the machine does the calculation. Energy setting for narrow and wide complex tachycardias with a pulse using a monophasic defibrillator. AEDs should not be used on patients with a pulse! Connect with me: Website:  https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!

The most common dysrhythmia during the first few minutes of cardiac arrest is ventricular fibrillation (V-Fib). The rapid delivery of a shock to convert a fibrillating heart is the intervention needed to convert the patient into a perfusing rhythm. Rapid defibrillation and early, high quality CPR are two factors that have been shown to improve defibrillation success. Review of inpatient and out-of-hospital cardiac arrests (OHCA) and the difference that CPR has on potential for successful defibrillation. Why public CPR and EMS dispatcher CPR instructions are important to improving OHCA survival outcomes. Connect with me: Website:  https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!

In this first part of our 2-part series on Cardiac Arrest Controversies Rob Simard, Bourke Tillman, Sara Gray and Scott Weingart discuss with Anton how best to ensure high quality chest compressions, the pros and cons of mechanical CPR, the literature on dual sequential defibrillation and optimizing pad placement, epinephrine vs vasopressin, amiodarone vs lidocaine, when to consider IV calcium and sodium bicarbonate, esmolol, airway considerations, sedation in cardiac arrest, the pros and cons of end-tidal CO2 and more... The post Ep 169 Cardiac Arrest Controversies – Chest Compressions, Dual Defibrillation, Medications and Airway appeared first on Emergency Medicine Cases.

Around the world, approximately 16,500 people die from sudden cardiac arrest every day due to delayed access to a defibrillator.We speak with Donovan Casey, co-founder, CEO and Executive chairman of Rapid Response Revival, a Sydney based medical technology startup hoping to improve these odds of survival by developing CellAED - a life-saving portable defibrillator for use in homes, workplaces and community spaces.  Co-hosts Caroline Duell and Dr Duncan Macinnis find out about the ten-year story behind Rapid Response Revival, the challenges of manufacturing medtech in the COVID era and how the product's registration in Europe and other markets around the world is a promising step. https://rapidresponserevival.com/

Remembering the different suggested energy settings for cardioversion and defibrillation when using different models or types of defibrillators has been made easier with biphasic & AED technology. AEDs are preprogrammed with a set energy setting to maximize the effectiveness of defibrillation. Biphasic defibrillators measure the impedance between the pads and will calculate the suggested energy for us. For monophasic defibrillators, set the energy at 360j and leave it. Cardioversion is similar when using a biphasic defibrillator; the machine does the calculation. Energy setting for narrow and wide complex tachycardias with a pulse using a monophasic defibrillator. AEDs should not be used on patients with a pulse! Connect with me: Website:  https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!

Immediately starting good, high quality CPR and delivering a shock as soon as possible have the largest impact on patient's outcomes after a cardiac arrest. For every minute that passes, our chance for successful defibrillation to a perfusing rhythm decreases. Good CPR increases our chance of successfully converting V-Fib into a perfusing rhythm. The CPR coach should monitor CPR quality and provide critical feedback to ensure we don't interrupt chest compressions for more than 10 seconds so we can maintain a chest compression fraction of at least 80%. Connect with me: Website:  https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!

พบกับ VPN podcast ในหัวข้อ CPR ; Advance life support (ตอนที่ 2) . ว่าด้วยแนวทางการทำ Defibrillation การให้ยาฉุกเฉิน การให้สารน้ำ การให้ออกซิเจน และอื่น ๆ . คุณหมอสามารถทบทวนเนื้อหา (ตอนที่ 1) เรื่องการเตรียมความพร้อมก่อนทำ CPR และวิธีการปั๊มหัวใจที่ถูกต้อง ได้ที่: https://www.facebook.com/vpn.magazine.online/videos/151862577051800 . บรรยายโดย น.สพ. วรรณสิทธิ์ จันทรวงศ์ . รับฟังกันแบบสด ๆ พร้อมกันได้ที่นี่ทาง Facebook LIVE

Our guests are John Mandrola and Bogdan Enache, returning to the show to wrap up our series on "Adventures and Misadventures in Defibrillation." GUESTS: John Mandrola, MD: https://twitter.com/drjohnm (Twitter) and https://drjohnm.org/ (Website) Bogdan Enache, MD: https://twitter.com/bogdienache?lang=en (Twitter) LINKS: Michel Accad. The case against shared decision-making http://alertandoriented.com/the-case-against-shared-decision-making-1/ (part 1), http://alertandoriented.com/the-case-against-shared-decision-making-2/ (part 2), and http://alertandoriented.com/the-case-against-shared-decision-making-part-3/ (part 3). RELATED EPISODES: https://accadandkoka.com/episode172/ (Ep. 172 Adventures in Defibrillation) https://accadandkoka.com/episode174 (Ep. 174 Misadventures in Fibrillation) WATCH ON YOUTUBE: https://youtu.be/2bJetodlboc (Watch the episode) on our YouTube channel Support this podcast

Our guests are Thomas Wingert, a patient, https://twitter.com/bogdienache?lang=en (Bogdan Enache), an electrophysiologist at Centre Hospitalier Princesse Grace in Monaco, and https://twitter.com/roguerad (Saurabh Jha), an Associate Professor of Radiology at the Perelman School of Medicine and the University of Pennsylvania. LINK: https://www.jacc.org/doi/10.1016/j.jacep.2021.03.006 (Point/Counterpoint on Halting the Implantation of Subcutaneous ICD). Editorial by B. Enache and J. Mandrola in JACC Electrophysiology. WATCH ON YOUTUBE: https://youtu.be/rKaZ8I1vn1Y (Watch the episode) on our YouTube channel Support this podcast

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

An irregular, often rapid heart rate that commonly causes poor blood flow. The heart's upper chambers (atria) beat out of coordination with the lower chambers (ventricles). This condition may have no symptoms, but when symptoms do appear they include palpitations, shortness of breath, and fatigue. Treatments include drugs, electrical shock (cardioversion), and minimally invasive surgery (ablation). Tikosyn: This medication is used to treat certain types of serious (possibly fatal) irregular heartbeat (such as atrial fibrillation/flutter). It is used to restore normal heart rhythm and maintain a regular, steady heartbeat. Dofetilide is known as an anti-arrhythmic drug. Cardioversion is a procedure used to return an abnormal heartbeat to a normal rhythm. This procedure is used when the heart is beating very fast or irregular. This is called an arrhythmia. Arrhythmias can cause problems such as fainting, stroke, heart attack, and even sudden cardiac death. Cardioversion is a medical procedure by which an abnormally fast heart rate or other cardiac arrhythmia is converted to a normal rhythm using electricity or drugs. Wikipedia People also search for: Catheter ablation, Defibrillation, Ablation, MORE Tachycardia refers to a heart rate that's too fast. How that's defined may depend on your age and physical condition. Generally speaking, for adults, a heart rate of more than 100 beats per minute (BPM) is considered too fast. Heart failure can occur if the heart cannot pump (systolic) or fill (diastolic) adequately. Symptoms include shortness of breath, fatigue, swollen legs, and rapid heartbeat. Treatments can include eating less salt, limiting fluid intake, and taking prescription medications. In some cases a defibrillator or pacemaker may be implanted. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/chrisabraham/message Support this podcast: https://anchor.fm/chrisabraham/support

From #CodaZero Live, David Carr chats with Sara Gray about treating recurrent ventricular tachycardia. A 50-year-old male arrives in the emergency room with chest pain. Upon examination, it is clear that he is experiencing recurrent episodes of V-tach. Defibrillation isn't working, so what happens next? Treating recurrent ventricular tachycardia with Dr Sara Gray. For more head to: codachange.org/podcasts

I februar 2018 skrev vi et blogpost om Double sequential defibrillation, bedre kendt som "DSD". DSD er brugen af to defibrillatorer på én patient, hvor man afgiver to stød samtidigt, i tilfælde af refraktær ventrikelflimmer. DSD har ikke tidligere været nævnt i de europæriske guidelines for behandling af hjertestop, men i de nye 2021 guidelines er det omtalt, og det kigger vi nærmere på i dette afsnit af FOAMmedic podcast.

In this podcast Dr. Demetri Yannopoulos, a interventional cardiologist with M Health Fairview and Interventional Cardiology Researcher Director with the University of Minnesota-Twin Cities, discusses ECPR (ECMO Cardiopulmonary Resuscitation), the recent Arrest Trial and the Mobile ECMO program. Enjoy the podcast! Objectives:     Upon completion of this podcast, participants should be able to: Define the importance of time and quality of CPR on outcomes from out-of-hospital cardiac arrest (OHCA). Explain the role of ECPR and ECMO teams in the management of out-of-hospital cardiac arrest (OHCA) refractory cardiac arrest. Review the current state of the art management of cardiac arrest and the reorganization of EMS/hospital response to out-of-hospital cardiac arrest (OHCA). CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks.  You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org. Click on the following link for your CME credit: CME Evaluation: "ECPR (ECMO CPR): The Cardiac Resuscitation Frontier with Dr. Demetri Yannopoulos (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for Continuing Education (CE) and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview and Ridgeview Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on this presentation. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Demetri Yannopoulos, MD has received honoraria from Helmsley Charitable Trust and the National Institute of Health (NIH) within the past 24 months, as a grant for research studies. Upon an independent review of his presentation, confirms he is following ACCME guidelines, and there is no commercial tie to the named agencies and no impact on his podcast presentation. Ridgeview's Continuing Education Committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. SHOW NOTES: Chapter 1: CPR was introduced in the 1960s. At the time, research at John Hopkins was being conducted on pigs in ventricular fibrillation and ventricular tachycardia who required defibrillation.  It was noted that when pushing defibrillation paddles against the chest wall, the arterial pressure of the subjects increased. It was concluded that with compression, pulsatile flow was generated. This was essentially the first iteration of closed chest CPR. Over the next 50 years or so, clinicians have been looking for better ways to improve survival outcomes. Key factors include early identification, early CPR, along with obtaining resources and assistance to improve ventilation, perfusion, and defibrillation. Poor predictors of survival for cardiac arrest include CPR for greater than 30 minutes and individuals with coronary artery blockage. With the integration of ECMO, it was found that by bypassing the heart and lungs and essentially taking on their functions, outcomes improved. Dr. Yannopoulos reiterates that CPR for greater than 30 minutes results in poor outcomes, thereby creating a goal to both normalize pressures during this time while also fixing the offending cause, such as a coronary artery occlusion.  Around 2015, in the Minnesota metro area, visionary EMS directors implemented an alternative option: If a patient fails three shocks, with ongoing CPR, the patient was transferred to a tertiary care facility with ECMO cannulation capabilities. Once on ECMO, these patients were transferred to the University of MN where they underwent PCI to evaluate for reversible causes such as occluded coronary vessels, PE, etc. Outcomes of this therapy showed 30-40% patient survival, which is a game changing result, thus the need for a randomized control trial, the ARREST Trial. Chapter 2: The ARREST Trial studied a group of patients with out-of-hospital cardiac arrest (OHCA) in ventricular fibrillation, refractory to defibrillation and initial ACLS treatment. This was a randomized control trial where one group was randomized to an ECMO intervention arm, versus a standard ACLS therapy arm. It was a phase 2, single center, open-label, adaptive, safety and efficacy randomized clinical trial.  Specific subject criteria included adults aged 18-75 with OHCA, refractory ventricular fibrillation, with no return of spontaneous circulation (ROSC) after three shocks, with an automated cardiopulmonary resuscitation device or LUCAS device and estimated transfer time shorter than 30 minutes. The primary outcome of the trial was survival to hospital discharge. Secondary outcomes included safety, survival and functional assessment at hospital discharge, at 3 months and 6 months after discharge. Results of the ACLS arm showed a 7% survivability, and zero at both three and six months, while the ECMO arm fared better with a 43% survivability. After enrolling 30 patients, the study was terminated at the first pre-planned interim analysis by the National Heart, Lung and Blood Institute after a unanimous recommendation from the Data Safety Monitoring Board, because the posterior probability of ECMO superiority exceeded the prespecified monitoring boundary. Cumulative 6-month survival was significantly better in the early ECMO group compared to the standard ACLS group. No unanticipated serious adverse events were observed. Conclusion: early ECMO-facilitated resuscitation for patients with OHCA and refractory ventricular fibrillation, significantly improved survival to hospital discharge compared with standard ACLS treatment. Chapter 3:  The Minnesota Mobile Resuscitation Consortium or MMRC, which was the first program to serve an entire metropolitan area in order to rapidly deliver extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation to patients with refractory ventricular fibrillation/ventricular tachycardia (VF/VT) out-of-hospital cardiac arrest (OHCA). This was an observational cohort study that analyzed consecutive patients prospectively enrolled in the MMRC's ECMO-facilitated resuscitation program. Entry criteria were identical to the ARREST Trial, adults 18-75 with an out-of-hospital cardiac arrest in VF or CT with no return of spontaneous circulation post 3 shocks, use of a LUCAS or automated cardiopulmonary resuscitation device, and an estimated transfer time of less 30 minutes. The primary endpoint was functionally favorable survival to hospital discharge with Cerebral Performance Category (CPC) 1 or 2. CPC 1 results in good cerebral performance: conscious, alert, able to work, that might have some mild neuro or psych deficits. CPC 2 results in moderate cerebral disability; conscious, sufficient cerebral function for independent activities of daily living (ADLS). Secondary endpoints included 3-month functionally favorable survival. Between the period of December 1, 2019 and April 1, 2020, 63 consecutive patients were transported, and of these 58 were treated by the mobile ECMO service. Post EMCO treatment 25 of the 58 or 43% were both discharged from the hospital and alive at 3 months with CPC 1 or 2. This first, community-wide ECMO-facilitated resuscitation program in the US demonstrated 100% successful cannulation, 43% functionally favorable survival rates at hospital discharge and 3 months. Chapter 4:  As the research continues, reaching 25-30% positive outcomes would be adequate to start a viable program. Dr. Yannopoulos speculates that with overall system improvement and refined protocols, that number can be as high as 70-80%, which is an incredible number. The future of ECPR will require a combined effort of the healthcare systems, policy makers, administrators, and communities. With a successful program in the urban and suburban areas, future research can hopefully expand access to more rural populations. Dr. Yannopoulos emphasizes that this is not a hospitalized based program, it relies on the EMS system, and those providers, especially medics, are key to the success of the program. At the time of this interview, the mobile ECMO program was on hold due to COVID, but currently the mobile ECMO program has a pending restart date of March 1st. Thanks for listening.

In this, our second podcast recapping our most recent journal club, Dr. Colleen Laurence summarizes a recent pilot study by Cheskes et al looking at standard defibrillation vs vector change defibrillation vs dual sequence defibrillation. Could we be on the verge of a significant practice change in how we deliver defibrillation to patients with refractory V Fib/Tac?

Podcast summary of articles from the October 2020 edition of the Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include CT scan accuracy, pediatric appendicitis ultrasound, myasthenia gravis, double defibrillation, pH in cardiac arrest, and board review on RSI drugs.  Guest speaker is Dr. Michael Pergola.

Does double defib work? Does it improve your chances of walking out of the hospital? What’s your CPC score? What is a CPC score? And how exactly do you conduct this procedure. In this episode, recorded live at ACEP 2019, Dr. Tiffany Proffitt discussed the ins and outs of double defibrillation with Dr. Mark Ramzy. Host: Tiffany Proffitt DO, MABS Attending Physician, Honor Health, Scottsdale, AZ Guest Panel: Mark Ramzy, DO, EMT-P, Critical Care Fellow at University of Pittsburgh, Chair of the EMRA Critical Care Committee. Suggested References: Dr. Ramzy’s very own presentation and sources on Double Defibrillation: https://docs.google.com/document/d/1VlkBhMOYT5oi93fPD8Q1B-JOMETkrY_vDl7r3zq2-JQ/ El Tawil C, et al. Double sequential defibrillation for refractory ventricular fibrillation. Am J Emerg Med. 2017; PMID: 28978402 Hajjar K et al. Dual defibrillation in patients with refractory ventricular fibrillation. Am J Emerg Med 2018. PMID: 29730094 S. Cheskes, et al. Double sequential external defibrillation for refractory ventricular fibrillation: The DOSE VF pilot randomized controlled trial. Resuscitation 2020; PMID: 32084567 Ramzy M, "The DOSE VF Pilot RCT: Double Sequential External Defibrillation for Refractory Ventricular Fibrillation", REBEL EM blog, March 26, 2020. Available at: https://rebelem.com/the-dose-vf-pilot-rct-double-sequential-external-defibrillation-for-refractory-ventricular-fibrillation/. Hamilton R, Ramzy M. Dual defibrillation is highly variable: an analysis of pulse interval delivered in dual defibrillation. Prehospital Emergency Care. 2019 PMID 31116612 Additional Readings: EmCrit.org - Double Defibrillation REBEL EM - Double Defibrillation Key Points: Make sure the case is appropriate for the use of Double Defibrillation. Two defibrillators of the SAME brand. Pads, like your kids, do NOT TOUCH EACH OTHER! Completely anterior or anterior and posterior approach.  Hit the buttons at the same time. Try not to shock yourself or ruin your defibrillator.

Double sequential external defibrillation (DSED) is a potential new intervention for patients in ventricular fibrillation who don't respond to traditional resuscitation, but it has yet to be supported by sound evidence. EMS World's Jonathan Bassett sits down with paramedic, researcher and educator Ian Drennan to discuss his research into the novel method and his article in EMS World's July 2020 issue.

Commentary by Dr. Valentin Fuster

This month we tackle a number of topics.  Garrett Sterling is back again with Zack Shinar to talk about cutting edge resuscitation, ECMO, and the interplay between the two.  Dual sequential defibrillation, CT after ECMO initiation, should you perform bystander CPR in the era of Covid, some US ECMO data, and an awesome 3D modeling for ECPR training models.  All in one 30 minute podcast! The post 65: ECPR Journal Club: Dual Sequential Defibrillation, CT after ECMO, and much, much more appeared first on ED ECMO.

Using electrical therapy for defibrillation, cardioversion and pacing can be intimidating at the bedside. This webinar will provide practical tips and strategies for successful use of energy for all these situations. In addition, newer evidence for vagal manoeuvres for SVT will also be discussed. 

Tuesday

Drs. Raja and Pescatore admit it’s cool to do hands-on defibrillation, but does that mean you should do it? They also talk about a new device to treat CO poisoning when the hyperbaric chamber isn’t available, and whether EPs should be cardioverting every AF patient.

This one is sure to generate some controversy, especially by my fellow #FOAMed colleagues but it is a conversation we need to have in all earnest.  We must seriously consider if double sequential defibrillation (DSD) is as good a plan as we may have originally thought.

Mike Matthews talks about being interested in the Bay Area again, being leery of pastors who talk about the Rapture, and the one question you should never ask when calling someone. Plus it’s Chely Shoehart, Floyd the Floorman, and John Deer the Engineer. Next show it's Benita, the Disgruntled Fiddle Player, and the Brewmaster.

Mike Matthews talks about being interested in the Bay Area again, being leery of pastors who talk about the Rapture, and the one question you should never ask when calling someone. Plus it’s Chely Shoehart, Floyd the Floorman, and John Deer the Engineer. Next show it's Benita, the Disgruntled Fiddle Player, and the Brewmaster.

This podcast is based on the Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients (FEEL) Study, and inferences made from it. The study was to determine the feasibility of prehospital ultrasound, but there were more astonishing results: 74.5% of patients in (pseudo) PEA had cardiac activity. 35% of patients in (suspected) asystole had cardiac activity.  We brought on EMS Physician Walt Lubbers to answer whether or not ultrasound would inform our decision making or alter how we manage a patient in cardiac arrest.   What we really wanted to know is 1) should we shock asystole "just in case" it could be very fine VF, and 2) would the presence of cardiac activity on ultrasound change how we manage a patient in cardiac arrest.  We discussed in detail some cardiac arrest physiology and referenced a video lecture and studies cited by Dr. Peter Kudenchuk from the Resuscitation Academy.

This week we delve into the world of novel means for epicardial pacing and defibrillation in small children or those with congenital heart disease. Dr. Bradley Clark of The Children's Hospital at Montefiore and Dr. Yaniv Bar-Cohen of Children's Hospital of LA discuss their recent works on developing minimally invasive epicardial pacing and defibrillation in infants and those with congenital heart disease. The ability to provide epicardial pacing or defibrillation without the need for a surgical incision is exciting and both experts speak of the challenges and future of this important work.

This week we delve into the world of novel means for epicardial pacing and defibrillation in small children or those with congenital heart disease. Dr. Bradley Clark of The Children's Hospital at Montefiore and Dr. Yaniv Bar-Cohen of Children's Hospital of LA discuss their recent works on developing minimally invasive epicardial pacing and defibrillation in infants and those with congenital heart disease. The ability to provide epicardial pacing or defibrillation without the need for a surgical incision is exciting and both experts speak of the challenges and future of this important work.

In this episode, Dr's J, Santhosh, and Ward discuss representation of medicine in movies. Along the way, they cover the show ER, newborns in film, SAG birth memberships, birth goop and placenta juice, Pulp Fiction and chest needles, defibrillators and shockable rhythms, crisis grooming, CPR survival rates, the worst film cpr ever performed, cardiac thumps, Million Dollar Baby and ventilators, intraoperative awareness, bullet wounds and more! So sit back as we take a deep cut of movie medicine!SOurces1)https://www.theguardian.com/film/2016/may/12/secret-lives-of-moviestar-babies-hollywood2) Ofole UM et al, Defibrillation in the movies: a missed opportunity for public health education, Resuscitation. 2014 Dec; 85(12): 1795–1798.3)The incidence of awareness during anesthesia: a multicenter United States study, Sebel, PS et al, Anest. Anal. 2004 Sep;99(3):833-9, Department of Anesthesiology, Emory University School of MedicineContact Us!Twitter: @doctorjcomedy @toshyfroFacebook: https://www.facebook.com/travelmedicinepodcastSquarespace: https://www.travelmedicinepodcast.squarespace.comPatreon: https://www.patreon.com/travelmedicinepodcastGoogle Voice: (872) 216-1586Find and Review Us on itunes, stitcher, spokeo, google play, or wherever podcasts are availableitunes: https://itunes.apple.com/us/podcast/episodes-travel-medicine-podcast/id914407095stitcher: http://www.stitcher.com/podcast/travel-medicine-podcast?refid=stprGoogle Play: https://play.google.com/music/listen#/ps/Iebqxcseb4s6pu5sjyljwgqsbuyYouTube: https://www.youtube.com/playlist?list=PLr4fcpX27x2vcJT_zJq6qiBy0pK8WiEXe

For this episode, we bring in an expert and an esteemed guest to answer all of your burning questions about resuscitation of cardiac arrest. Part man, part mystery, but wholly dedicated to furthering excellence in out of hospital care: Dr. Walt Lubbers, MD. Some background: Walt is an Emergency and Prehospital Medicine physician who holds board certification in both EM and EMS. He's also an Assistant Professor of Emergency Medicine and Attending Physician at University of Kentucky Medical Center. If that wasn't enough, he's also the Medical Director of several EMS agencies throughout Central and Eastern Kentucky.

Commentary by Dr. Valentin Fuster

MSM Podcast Episode 7- Dual Sequential Defibrillation We’ve mentioned plenty of time on this podcast that we have no real idea what we’re doing for cardiac arrest patients. The guidelines we work are not always consistent with the science. There’s a lot of interventions we perform simply because “that’s what we’ve always done.” But the fact remains, that the interventions ... Read More The post MSM Podcast Episode 7- Dual Sequential Defibrillation appeared first on Medschoolmedic.

Guidelines. Algorithms. Evidence based medicine. These all play a significant part in the safe and effective management of the majority of our patients. As a result there is a danger that treatment pathways are followed blindly without critiquing their use and there is real risk we can loose sight of what’s best for the patient in front of us. Guidelines encourage inflexible decision making, which creates further challenge when we are met by patients who do not fit standard treatment pathways. If this is the case then the management of cardiac arrest, which is taught and delivered in a didactic and protocol driven fashion, is surely the pinnacle of the problem. Standard Advanced Life Support (ALS) is totally appropriate for the majority of cardiac arrests, but what happens when it fails our patients? Refractory ventricular fibrillation (rVF) is, by its very nature, defined by the failure of ALS, but frustratingly there is very little evidence, or guidance, surrounding how to manage this patient group. I was faced with this situation when called to support an ambulance crew who were resuscitating an out-of-hospital VF arrest. When benchmarked against the ALS guidelines their management had been exemplary, but the patient remained in VF after eight shocks. So what now? The UK Resuscitation Council doesn’t specifically discuss rVF, but offers the advice that it is “usually worthwhile continuing” if the patient remains in VF. Not a particularly controversial statement, but not much help either. They do discuss the potential for ECMO use, but this is currently a very rare option in UK practice, or thrombolysis for known or suspected pulmonary embolism. Other potential interventions not in the guidelines include IV magnesium and placing defibrillator pads in the anterior-posterior orientation. PCI can also be considered if there is a suitable receiving centre available and the patient can be delivered in a safe and timely fashion. A final option is the use of double sequential defibrillation (DSD), using two defibrillators, charged to their maximum energy setting, to deliver two shocks in an almost simultaneous fashion.DSD was first described in human subjects in 1994 when it was used to successfully defibrillate five patients who entered rVF during routine electrophysiologic testing. These patients were otherwise refractory to between seven and twenty single shocks. Looking at the available literature there has been little interest in DSD since then, until the last two to three years when it appears to have undergone a small revival. Sadly, there is no evidence for its use beyond case reports and small case series. The case reports appear to show good results with four in the last two years reporting survival to discharge with good neurological outcome. There are also a handful of other cases discussed in online blogs and articles with good outcomes. But these case reports and articles almost certainly represent an excellent example of publication bias. The most recent case series reviewed the use of DSD by an American ambulance service over a period of four years. During this time DSD was written into their refractory VF protocol, with rVF defined as failure of five single shocks. The study included twelve patients, three of whom survived to discharge with two of these demonstrating a cerebral performance score of 1. Despite appearing to demonstrate reasonable outcomes for DSD, sadly this study has a number of significant limitations. One important point the authors fail to discuss is that the two neurologically intact survivors received their DSD shocks after two and three single shocks respectively, not after five shocks which would have been per-protocol and consistent with the authors definition of refractory VF. This highlights a further problem with analysing the use of DSD. Not only is there a dearth of high-level evidence, but the literature that is available is highly inconsistent. There are a range of definitions for refractory VF, different orientations for the second set of pads, variable interventions prior to using DSD, a variety of timings between the shocks and so on. This means that comparison between studies and drawing meaningful conclusions is nearly impossible. Given these challenges, what are the explanations for why DSD might work? The first theory is that by using DSD the myocardium is defibrillated with a broader energy vector compared to a single set of pads resulting in a more complete depolarisation of the myocardium. A second theory is that the first shock reduces the ventricular defibrillation threshold meaning that the second shock is more effective. A third explanation may simply be the large amount of energy delivered to the myocardium. These theories should be tempered by the fact that studies have demonstrated increasing defibrillation energy to result in increased defibrillation success, but only up to a plateau. After this the success of defibrillation drops sharply. Increased energy use has also been demonstrated to cause an increase in A-V block but without an associated increase in shock success or patient outcome. The use of double sequential defibrillation is clearly an area that would benefit from further research, but despite this it is interesting to note that London Ambulance Service have enabled their Advanced Paramedic Practitioners to use DSD and some American EMS systems have written DSD into their protocols. So returning to the case in point what did I choose to do with my patient? After changing the pad position, administering magnesium and continuing defibrillation they remained in VF.  I considered transport to a hospital with interventional cardiology but the patient was several stories up in a property with an inherently complex extrication. So I chose to use DSD because I felt that all other avenues had been explored. The patient had suffered a witnessed arrest, received bystander CPR immediately and throughout the resuscitation they had maintained a high end tidal CO2 and a coarse VF. I felt that this was a patient who could still respond to non-standard cardiac arrest management in the absence of a response to guideline directed treatment. After two DSD shocks a return of spontaneous circulation was achieved and the patient survived to hospital admission, but sadly didn’t survive to hospital discharge. We’re left with a even bigger question: if we accept that DSD is a potentially useful intervention in rVF, when should we consider using it? Would the outcome for this patient have been different if DSD had been used earlier? The European Resuscitation Council states that the use of double sequential defibrillation cannot be recommended for routine use. But treating rVF is not routine and the guidelines have otherwise failed our patient. It is said that insanity is defined as doing the same thing over and over again, without changing anything, and expecting a different result. Is this not what the guidelines preach in rVF? It is up to you, the clinician, to determine whether DSD is appropriate for each rVF case you encounter. But I urge you to consider the patient in front of you and tailor your resuscitation to their needs, whether that includes DSD or an alternative option. Personally, I believe DSD does have a place in the management of rVF patients, after considering the other interventions previously discussed. Given that shock success declines over time, DSD could be used as early as the sixth shock, because at this point the guidelines have nothing further to add. Or maybe it’s me who’s insane… James Yates (Critical Care Paramedic GWAAC) References Double sequential Defibrillation therapy for out-of-hospital cardiac arrests: the London experience. Emmerson AC, et al. Resuscitation. 2017  A Case Series of Double Sequence Defibrillation. Merlin MA. Prehosp Emerg Care. 2016 Double sequential external shocks for refractory ventricular fibrillation. Hoch DH. J Am Coll Cardiol. 1994 Double Sequential External Defibrillation in Out-of-Hospital Refractory Ventricular Fibrillation: A Reportof Ten Cases. Cabañas JG. Prehosp Emerg Care. 2015 Double Sequential Defibrillation for Refractory Ventricular Fibrillation: A Case Report. Lybeck AM. Prehosp Emerg Care. 2015 Double simultaneous defibrillators for refractory ventricular fibrillation. Leacock BW. J Emerg Med. 2014 Simultaneous use of two defibrillators for the conversion of refractory ventricular fibrillation. Gerstein NS. J Cardiothorac Vasc Anesth. 2015 Use of double sequential external defibrillation for refractory ventricular fibrillation during out-of-hospital cardiac arrest. Cortez E. Resuscitation. 2016  Double Sequential External Defibrillation and Survival from Out-of-Hospital Cardiac Arrest: A CaseReport. Johnston M. Prehosp Emerg Care. 2016 Dual defibrillation in out-of-hospital cardiac arrest: A retrospectivecohort analysis. Ross EM. Resuscitation. 2016 Refractory Ventricular Fibrillation Successfully Cardioverted With Dual Sequential Defibrillation. Sena RC. J Emerg Med. 2016 Dual sequential defibrillation: Does one plus one equal two? Deakin CD. Resuscitation. 2016 Magnesium therapy for refractory ventricular fibrillation. Baraka A. J Cardiothorac Vasc Anesth. 2000 

Double Sequential Defibrillation Double sequential defibrillation is a procedure that may be helpful in the treatment of refractory ventricular fibrillation (RVF) in the out of hospital environment. This module demonstrates the procedure of double sequential defibrillation which is included as a medical control consideration for instances in which ventricular fibrillation persists after five shocks. Further research will be required to determine the optimal treatment strategies for RVF. Double sequential defibrillation is not considered part of the minimum standard of care at this time. Nonetheless, providers will be instructed on how to properly perform this procedure in the event that a medical control order is granted for this treatment option. Cast in Alphabetical Order: Michael T. Benenati, BS, AAS, EMT-P Tyler F. Cominsky, NRP Seth Goldstein, BA, AS, AEMT-P/CIC Susie Surprenant, BBA, BS, NRP David Violante, MPH, MPA, AEMT-P Faizan H. Arshad, MD @emscritcare Christopher J. Fullagar, MD, EMT-P, FACEP @87MD1

A few quick tips to help increase the success of defibrillating a patient in persistent ventricular fibrillation.

Ep #33 Double Sequence Defibrillation - A Journey through the Literature with Dr. Phil Moy @PECPodcast   Check out Dr. Phil Moy weave this elegant tale on the evolution of prehospital double sequence defibrillation.  He interviews 3 different author groups who recently published their work in Prehospital Emergency Care, the journal of the NAEMSP (National Association of EMS Physicians). PEC Podcast: http://pecpodcast.libsyn.com/ PEC Journal: http://naemsp.org/Pages/pecjournal.aspx NAEMSP Website: http://naemsp.org/Pages/default.aspx   Also find my friends and fellow prehospital physician podcasters on Twitter: Joelle Donofrio @PEMEMS Jeremiah Escajeda @JerEscajeda Scott Goldberg @EMS_Boston     Sponsored by @PerfectCPR Apple Watch App with Audio and Haptic Feedback to Optimize Cardiac Arrest Training and Improve Quality of CPR Delivery PerfectCPR.com     Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org  

Ep #34 A Case Series of Double Sequence Defibrillation w/ @emscritcare & @ccareanywhere   Dr. Phil Moy of the @PECPodcast expertly interviews me regarding our recent publication in this month’s Prehospital Emergency Care.  We dive into the inspiration behind the study, the challenges behind the protocol and the development and deployment of our treatment algorithms.  We conclude with our overall experience and directions for future research.    Article Link: http://www.ncbi.nlm.nih.gov/pubmed/26848018   PEC Podcast: http://pecpodcast.libsyn.com/ PEC Journal: http://naemsp.org/Pages/pecjournal.aspx NAEMSP Website: http://naemsp.org/Pages/default.aspx   Also find my friends and fellow prehospital physician podcasters on Twitter: Joelle Donofrio @PEMEMS Jeremiah Escajeda @JerEscajeda Scott Goldberg @EMS_Boston     Sponsored by @PerfectCPR Apple Watch App with Audio and Haptic Feedback to Optimize Cardiac Arrest Training and Improve Quality of CPR Delivery PerfectCPR.com     Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org  

BMC Mazwi, M Introduction To Defibrillation Podcast 051616 by OPENPediatrics

Pastor JR Polhemus May 8, 2016 For more information, visit us at http://www.therock.org If you'd like to give to our church, you can do so online at https://therock.ccbchurch.com/w_give_online.php Facebook: https://www.facebook.com/rockchurchco Give: https://therock.ccbchurch.com/w_give_online.php Instagram: http://instagram.com/rockchurchco Soundcloud: https://soundcloud.com/the-rock-real-community Twitter: https://twitter.com/rockchurchco Vimeo: https://vimeo.com/therockrealcommunity Website: http://www.therock.org

Pastor Jeff Drott April 24, 2016 For more information, visit us at http://www.therock.org If you'd like to give to our church, you can do so online at https://therock.ccbchurch.com/w_give_online.php Facebook: https://www.facebook.com/rockchurchco Give: https://therock.ccbchurch.com/w_give_online.php Instagram: http://instagram.com/rockchurchco Soundcloud: https://soundcloud.com/the-rock-real-community Twitter: https://twitter.com/rockchurchco Vimeo: https://vimeo.com/therockrealcommunity Website: http://www.therock.org

Pastor JR Polhemus April 17, 2016 For more information, visit us at http://www.therock.org If you'd like to give to our church, you can do so online at https://therock.ccbchurch.com/w_give_online.php Facebook: https://www.facebook.com/rockchurchco Give: https://therock.ccbchurch.com/w_give_online.php Instagram: http://instagram.com/rockchurchco Soundcloud: https://soundcloud.com/the-rock-real-community Twitter: https://twitter.com/rockchurchco Vimeo: https://vimeo.com/therockrealcommunity Website: http://www.therock.org

Pastor JR Polhemus April 10, 2016 For more information, visit us at http://www.therock.org If you'd like to give to our church, you can do so online at https://therock.ccbchurch.com/w_give_online.php Facebook: https://www.facebook.com/rockchurchco Give: https://therock.ccbchurch.com/w_give_online.php Instagram: http://instagram.com/rockchurchco Soundcloud: https://soundcloud.com/the-rock-real-community Twitter: https://twitter.com/rockchurchco Vimeo: https://vimeo.com/therockrealcommunity Website: http://www.therock.org

Ep #9 - Simulation - Double Sequential Defibrillation in refractory VF & Lecture by @ccareanywhere on #DSED   Hot off the press! Our case series on #DSED just accepted for publication in Prehospital Emergency Care: http://www.tandfonline.com/eprint/ZQsRHp54MWXAIkCsUiAi/full     REBEL EM: Beyond ACLS http://rebelem.com/beyond-acls-dual-simultaneous-external-defibrillation/ EMS World: Hold the Coroner http://www.emsworld.com/article/10318805/double-sequential-defibrillation PEC: Cabanas et al http://www.ncbi.nlm.nih.gov/pubmed/25243771     Follow us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org    

[Read the Article] Out-of-hospital cardiac arrest is a major public health issue, accounting for approximately 200,000 deaths per year in the United States. A new study examined whether increased use of defibrillators and cardiopulmonary resuscitation (CPR) by first responders and bystanders could help increase survival for people who experience an out-of-hospital heart attack.In recent years, statewide initiatives in North Carolina have encouraged improvement in the use of CPR and automated external defibrillators (AEDs) by training more members of the general public.Bystander-initiated CPR was associated with a greater likelihood of survival with favorable neurologic outcome. The combination of bystander CPR and first responder defibrillation increased from 14 percent in 2010 to 23 percent in 2013. Results found, patients who received bystander or first responder interventions before arrival of the emergency medical services (EMS) were more likely to survive compared to those who received EMS intervention alone. [Watch more videos of The JAMA Report] JAMA Report videos provided pursuant to license. ©2015 American Medical Association, publisher of JAMA® and The JAMA Network® journals.

[Read the Article] Out-of-hospital cardiac arrest is a major public health issue, accounting for approximately 200,000 deaths per year in the United States. A new study examined whether increased use of defibrillators and cardiopulmonary resuscitation (CPR) by first responders and bystanders could help increase survival for people who experience an out-of-hospital heart attack.In recent years, statewide initiatives in North Carolina have encouraged improvement in the use of CPR and automated external defibrillators (AEDs) by training more members of the general public.Bystander-initiated CPR was associated with a greater likelihood of survival with favorable neurologic outcome. The combination of bystander CPR and first responder defibrillation increased from 14 percent in 2010 to 23 percent in 2013. Results found, patients who received bystander or first responder interventions before arrival of the emergency medical services (EMS) were more likely to survive compared to those who received EMS intervention alone. [Watch more videos of The JAMA Report] JAMA Report videos provided pursuant to license. ©2015 American Medical Association, publisher of JAMA® and The JAMA Network® journals.

Commentary by Dr. Valentin Fuster

Heart Palpitations and Defibrillation

Heart Palpitations and Defibrillation