The future is now. If you want your patient to walk out of the hospital, get them on ECMO and open up those coronaries - jshibata


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VT, VF, and Electrical Storm

He has no pulse, so you start chest compressions. Initial rhythm is PEA so you give epinephrine and continue compressions as the patient is successfully intubated. The second rhythm shows ventricular fibrillation (VF). You think to yourself, “Great this guy might actually have a chance!” You’re feeling pretty good as you administer a shock and then resume compressions. It’s time for the next rhythm and pulse check, and the rhythm is still VF. You shock again, resume CPR, give epinephrine, and ask the nurse to pull up amiodarone 300mg as you anxiously await the next check. Rhythm is still VF.

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 VT, VF, and Electrical Storm

You’ve shocked this guy 4-5 times and he still has VF and occasionally what looks like pulseless VT. Do you just keep shocking this guy?! Answer: = Yes.. and maybe even give a double shock. DOUBLE SHOCK????

Beyond ACLS: Dual Simultaneous External Defibrillation

For those of us in the trenches of the emergency department, we have to think beyond ACLS at times. Although VF typically responds very well to the standard energies of defibrillation, maybe in patients with higher body mass index or morbid obesity we need higher energies to achieve successful defibrillation.

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