I am forever grateful to this patient for allowing the team to record his cardioversion, as I am studying for my PALS this is very helpful. Thank you for uploading the video as well.
I'm a paramedic student and just started this week working in the ER as a tech.. we had this happen yesterday. Our patient came in with the medics with a pulse of 263. With the cardioversion, we got her down to 93. Truly incredible to see in person. Great job guys!
Had a patient last night (in the field) call 911 for chest pain. Pt's heart rate was bouncing from 140-160. During the transfer to the gurney (five steps--maybe), Pt. stumbled and almost fell. They then started complaining about increasing chest pain. Re-evaluated rate, and it had jumped to 230-240/min. IV access established, good dose of Etomidate and shock at 200J (patient was well over 200 kg). Converted, and chest pain was relieved. Naturally the Pt. didn't remember a thing! Great video BTW.
So the heart rate isn’t the whole issue. If your heart is fast but in sinus rhythm the cardio version won’t work. The rhythm and fluttering of the heart is what’s dangerous
Wait a minute! Why wasn't he sedated? I got shocked once, but they gave me a knockout and I felt nothing. I can't imagine how much it would hurt if I was awake.😮😮
Thank you for posting! I've been rushed to the ER once with SVT, and have been in it several times before that night. Im thankful Adenosine worked on me that night in the ER.... but now I know what to expect if I have another trip..
Haha, the nurse saying shock him now when the doctor was putting the mask on is hilarious. Bless those nurses in the room, you can tell the truly care about the people. Did I hear right that he may be detoxing? I love seeing care practitioners that still treat people like people even if they use. ❤
Almost had this done to me in March of 2020. Luckily my heart reset itself and I did not need that to be done to me. Trust the polyvagal theory and much love given to the subject in this video!
Carlo, I doubt we have much more than you have, but teaching is what is so much fun. Based on the quality of your videos (and time required to make them), it's obvious you have the "teaching bug".
Would just like to say a huge THANKS for all of the videos that you post Dr Mellick! I am a junior Dr and I find these to be fantastic learning tools! Thanks again!
Thank you so so much for making these videos, there is only so much you can learn from text book/lectures.... actually seeing the procedure on video is really helpful... Thanks again, from the UK!
+Donovan Alvarado ... You don't have much choice in a situation like that. The superheroes are the medical staff and "modern medicine". I ended up having ablation after quite a few emergency room visits and adenosine pushes. The last time (before ablation), it took two shots of adenosine; I never considered that one wasn't enough. So when the second one worked and I asked the doctor "what if that hadn't worked?" and he shrugged and said, "the paddles?", I said, "okay, enough is enough". I had ablation 10 years ago and even though the v-fib can happen (in another spot) someday, so far, so good!
they can't sedate because the reason that high of heart rate is dangerous is due to the low blood pressure becuase the heart isn't really able to pump fully, fluid dynamics and stuff like that it's so if they sedated him his blood pressure would probably drop further which could kill the patient
Good Video. Only when you push the shock button remember to make sure to clear the table and make sure no one is in contact with the patient. It is also a good idea to look at the patient as you push the shock button just to make sure no one is too close. Really enjoyed this.
I have been troubled with SVT issues this past year. The highest was 223bpm possibly higher I’ve had issues with ectopic beats over the years and I learned to live with them but this recent development has been sudden. I was rushed into hospital several weeks ago because I had an SVT following a bad asthma attack. Probably due to the amount of salbutamol needed in the nebulizer to stabilise my breathing. Normally it will make my heart beat very fast but by the time paramedics arrived and had me hooked up to everything they started asking if I had a heart condition, so I said I have SVT issues and they said that I was having one. Initially I thought it was a mistake and they said no I became very dizzy. I thought I was going to pass out they said they needed to take me to hospital because my heart rate was sitting at 200bpm for half an hour. I tried to convince them to wait longer but they said no it was very dangerous! I was surprised because I didn’t think it was dangerous just uncomfortable to experience. They said they would have to use blue lights and not to be frightened by it but it was to make sure they got me to hospital faster. Normally it’s a half hour ride to the hospital. My heart rate was beginning to drop by the time we reached the hospital. The SVT often starts suddenly and disappears very quickly. It’s really weird and since that episode several weeks ago my heart is doing weird things. I haven’t slept much these past few days because constant ectopic beats and flutters are keeping me awake. It’s very uncomfortable and a lot of pressure sometimes pain in the chest neck and jaw. I can assure you that if I call a doctor they will ask things do I have any chest pain? The answer would be yes coming and going. Then they would immediately send an ambulance. The problem is I have other major medical conditions so I dread A+E I’m wheelchair reliant now so it’s extremely difficult to cope with. I will say that the paramedics have been hero’s and the nurses and doctors have been fantastic. I’ve been in and out lots this year for asthma and diabetes. They really are amazing! I am not a doctor so I have no idea why this is happening. I don’t know enough about it. The pain I’ve probably pulled a muscle again. Are these normal symptoms? It’s not usually frequent. I’m exhausted and just need to sleep 😴
I am having this procedure tomorrow morning at Peninsula Hospital south of Melbourne Victoria Australia. I am glad I watched this so I know what to expect. Doctor and nurse say, all good, no big deal but seeing it down is terrific. Thanks to the gentleman and the medical team.
Don't be afraid of cardioversion. I've had 5 within 13yrs. It took me out of trouble many times with arrythmias. I was sedated and didn't feel anything.
Lucio Castro well you probably don’t remember feeling anything haha. It’s almost fun cardioverting people when they’re sedated. They’re sleeping and then they start screaming and then go back to sleep
Hi Olga, Yes, the emergency physician in this video determined that his blood pressure was low and didn't want to use the propofol that we commonly use. Versed was administered and I think pain medication was given. This combination isn't as effective and I think if we were to do this over we would take a little more time to look at other options that do not drop you blood pressure.
This happened to me. Zero risk factors. No history. Just happened one day. Went to ER and spent a night getting drugs to slow my heart rate down enough for cardioversion. Propofol, jolt, wake up, go home. Will likely never happen again.
I went through a bad period of Afib through 2021/2022 and was cardioverted six times over eighteen months. It felt like I'd stepped into a Hell from which there was no escape. My heart rate would rise to typically between 140bpm and 180bpm. I thought that was bad, but what must it be like to be 250bpm? I don't think I'd be able to survive that. One thing I do know is that the sense of relief, peace and calm after cardioversion is beyond my ability to fully describe, but, it's the best feeling in the world. I still live with paroxysmal Afib, and awaiting catheter ablation, but in the meantime I learned to recognise the triggers that set it off, and some methods to get it back under control. Even so, I've still had episodes that can last as long as 36 hours, and can still be just as frightening. I hope the chap in the video gets his relief from his heart condition.
PVCs and PACs are fairly normal. Long runs of rapid heart beats are not. Coffee, caffeine and probably stress and fatigue can increase their frequency.
Sophie Harrington I had a pulse of 200 during my tonsillectomy back in 2011. I had a major bleeding event five days after the initial procedure in which I estimate myself to have lost about 35% of my blood.
I have an ICD which, unfortunately, doesn't deliver a sedative before deploying, lol. This condition is really scary for me. There is nothing I can do to control it at all. I cannot just take deep breaths or anything, well sometimes coughing can trick it, it either has to resolve itself or be "shocked" back into rhythm. I wish this gentleman a whole lot of luck and good health in the future.
Thank you very much for that info!, I will deff check into it. I will be learning from Dr M , and his helpful and informative vids could very well save a life. Thanks ~
Also glad to see that someone other than me, Jake Adams, knows that Oxygen does not burn. It simply supports combustion at a higher rate than the normal air we breathe.
Nice Video Dr Mellick, thank you so much for sharing it! I'm a nurse working on ambulance in italy, i have two question about this video: the first is: I know that the BP was too low and propofol was not indicated, why you didn't use a small bolus of benzos such as midazolam? And why provide high flow o2 with reservoir ? was the patient hypoxic befor the cardioversion or what? Thank you so much for any information!
Paramedic here. Wasn't the AHA recommended starting dose for synchronized cardioversion 50J in 2012? I'm not criticizing the treatment, just respectfully here to learn. Thanks for all of your videos, Dr. Mellick! I recommend them to my paramedic students.
My partner’s driving and New Orleans’ streets once converted an SVT for me. Pt was tach-ing along at 200 and I was in back preparing to start my IV and give her adenosine when he hit a bump hard. She momentarily came up off the stretcher (yes she was strapped in but not tight) and when she slammed back down she converted to sinus rhythm.
I agree with you Dr. Mellick. I watch you both, and I have learned so much from you both. I think Dr. Oller is well versed and does his research thoroughly. I believe he would be a fantastic teacher. He really already is through his videos. I admire you both. I get to see things that I don't get to see working in the environments that I work (now it is private duty), so I find it fascinating. My husband finds it gross and almost throws up...lol!!!
Yes you can, you just have to place one paddle 3 inches away from the pacemaker battery and the other a little lower on the ribs than you would usually do. By all means don´t put the paddle ON TOP of the battery. You could short circuit it and the patient would need to get a new one. But I tend to think they prefer to be alive and need a pacemaker change than dead with a perfectly working device.
It's probably safe to do with modern pacemakers... Manegold JC et al. External cardioversion of atrial fibrillation in patients with implanted pacemaker or cardioverter-defibrillator systems: A randomized comparison of monophasic and biphasic shock energy application. Eur Heart J 2007 Jul; 28:1731-8.
My dad just had this done yesterday morning 12hrs after his Heart Cath procedure. His heart was at 203bpm & BP was 70/40. They could only give 1mg of versed due to his low bp. He said it felt like he got kicked in the chest, seen flashing of a white light & swore he had burn marks on his chest. Thankfully he is back in normal sinus rhythm but now has to wear a life vest for 3 months in case of another episode.
Do they ever try to submerge the patients face in ice water? That would trigger the dive reflex and slow the rate down. I worked in an ER and we did this successfully with a pregnant woman.
That shock seemed brutal. I was admitted into the hospital bc my heart rate was up in the 200. I wasn’t in any pain. They gave me 2 doses of some meds that made me feel like a horse was sitting on my chest. Then my heart rate decreasing back to the normal rate. The diagnosis was Super ventricular tachycardia.
SVT with suspected ANVRT.... If vasovagals and adenosine fail, sync shocks won't. Always satisfying to see that heart rate and BP plummet back into normal ranges. But why was 100J used on the first shock? Normally we would start with a 50J shock. Nice job.
Great video! I wanted to ask if ketamine would have been preferable to versed considering the patient's hypotension but I forgot it could exacerbate his tachycardia. Followed!
Thanks for the info! I am new to tYT,didn;t understand in what capacity he was in these hospital, hospitals. I went to his channel but I am not very good at this YT stuff. At least now I understand why he is allowed to film all these incidents. and be able to help other people. I found his video when I was looking at a poor fellow with dry socket after tooth extraction. And I have been here for about 5 hours now!!! lol STILL looking for info on those injections he does for headache/facial pain!
dr mellick was this patient given emergency cardioversion and did work on this patient and was seen by cardiology in this case was his blood pressure low
I have a defibrillator implanted. One day my heart rate got so high that my defibrillator fired twelve times. It was not pleasant. I was in sinus rhythm for a month, but now I'm back in AFib and it sucks.
Most NON-Critical Care Transport teams and non-helicopter transport teams do not carry propofol. Would you recommend doing valsalva & what is the "decision point" you would recommend that the paramedics begin emergency cardioversion, i.e., if they are 10 min out, 20 min out, in the patients living room? I had a guy CAO with V-tach and the hospital was 5 min out. Asymptomatic. I left him alone/load&go. Do you agree? What post instructions did the other guy give besides Ativan? Strong accent.
It means he's probably in DT's, or about to experience them, or so I'm assuming they meant by stopping alcohol (EtOH). Plus I believe I heard them order Ativan and a banana bag - another indication that they're trying to control or prevent symptoms of alcohol withdrawal...
My unit routinely uses Levophed before cardioversion if the pressure falls either due to the tachycardia itself or to counteract sedation-induced hypotension. This would have allowed you to use full sedation. Perhaps there was a reason you guys didn't want to use pressors, but to each their own.
Larry! Love these videos. It would be awesome to do a video about you and your experience and maybe some "pearls" to emergency medicine. I love watching these as a medic. Why no Ketamine though? I know it's a fairly "new" (not new at all) medicine to old school providers. But it could've been valuable here I would imagine. Thanks for your input Dr. M!
Thanks, Michael. I wasn't the operator, but ketamine would possibly have been acceptable. I don't remember from 2012 why the decision was made to go without it.
Larry Mellick Thanks! I guess I failed to see the date of video as well. Although it's been around and used by many providers, it's a new "hot topic" drug now. Especially as it's been integrated into EMS and DSI is becoming more popular than RSI. THANKS AGAIN! You rock! LOVE these videos. Sometimes I make my shift mates watch them when they pertain to EMS and we discuss Benifits and risks of the videos we see. Have a great day!
khd2005 what exactly happened? There's a known risk called emergence syndrome. Causes psychotropic dreams from what o hear. I've also read a seemingly valid study that gave a little versed once hemodynamically stable and it put a kibosh on the emergence syndrome dreams/nightmares. It's a very safe drug in that almost every other drug for sedation drops blood pressure (which is bad bad bad for cardioversion or any cardiac procedure) and also decreases your respiratory drive. Thus... most providers are willing to compromise on wicked/vivid dreams.
@peacenow42I know that electric feeling you mean - it's like pins and needles, actually worse... and without the prickly feeling - just the vibrating kinda feeling. It's literally the feeling of no oxygen getting to our extremities, slowly moving up our limbs, towards the rest of our body... and it's bloody terrifying!
@peacenow42 That is interesting indeed! This sensation is rather still new to me, as I have only started experiencing it the past 8 months or so and I do not see it getting any better, unfortunately. I do recall my face and forehead get this numbness and tingling kinda feeling before the extremities start getting that electric feeling. Those long pauses must definitely not be a fun experience for you, poor thing!!! I can only imagine because 2 seconds seems like forever for myself. And when you say it eventually gets peaceful, that thought itself is terrifying!!! Literal fight or flight mode.
Just got discharged for an SVT. Granted I’m 23. But my HR hit 242 and I was walking around well enough to call for help. Rapid response team looked at me like I was crazy. Not a fun feeling, you feel like your heart is about to burst out your chest
I remember going upwards of 220 before an in office surgical procedure about 12 years ago. I was very anxious about the sedation and that was why my heart rate was going that high. I just felt the anxiety mostly, very little chest discomfort. I asked the attendant if it was safe to be sedated at that heart rate and she said no problem and put me to sleep lol.
Patient laying there with heart rate 255 and looking very healthy.... crazy! Good to see he is ok now
I am forever grateful to this patient for allowing the team to record his cardioversion, as I am studying for my PALS this is very helpful. Thank you for uploading the video as well.
There's nothing Pediatric about this guy.
I'm a paramedic student and just started this week working in the ER as a tech.. we had this happen yesterday. Our patient came in with the medics with a pulse of 263. With the cardioversion, we got her down to 93. Truly incredible to see in person. Great job guys!
Thank goodness for modern medicine and these excellent doctors.
As a nursing student watching videos like this is really helpful! Thank you!
Cool! I am glad they are helpful!
Had a patient last night (in the field) call 911 for chest pain. Pt's heart rate was bouncing from 140-160. During the transfer to the gurney (five steps--maybe), Pt. stumbled and almost fell. They then started complaining about increasing chest pain. Re-evaluated rate, and it had jumped to 230-240/min. IV access established, good dose of Etomidate and shock at 200J (patient was well over 200 kg). Converted, and chest pain was relieved. Naturally the Pt. didn't remember a thing! Great video BTW.
+Chris Reed Thanks! Challenging case!
Nice work
You did the cardioversion before monitoring on an EKG?
@@mohammadshahade8753 what are you talking about 🤣
When your heart rate exceeds the BPM of the techno music it’s time for cardioversion, brah.
😂😂😂😂😂
as someone who minors in music studies, this made me laugh
Underrated comment.
So the heart rate isn’t the whole issue. If your heart is fast but in sinus rhythm the cardio version won’t work. The rhythm and fluttering of the heart is what’s dangerous
Wtf
At least the nurse was completely honest with him telling him it’s gonna hurt like hell for a second
Wait a minute! Why wasn't he sedated? I got shocked once, but they gave me a knockout and I felt nothing. I can't imagine how much it would hurt if I was awake.😮😮
@@icdumppl2024 they do it's just light sedation
@@icdumppl2024he had low blood pressure
@@icdumppl2024 They said it. He was only partially sedated as he already had low blood pressure.
@@icdumppl2024 yeah.. they did say due to low bp
Big thank you to the gentleman letting us see this procedure. Very interesting and educational!
Good! Glad it was helpful.
Thank you for posting!
I've been rushed to the ER once with SVT, and have been in it several times before that night. Im thankful Adenosine worked on me that night in the ER.... but now I know what to expect if I have another trip..
Haha, the nurse saying shock him now when the doctor was putting the mask on is hilarious. Bless those nurses in the room, you can tell the truly care about the people. Did I hear right that he may be detoxing? I love seeing care practitioners that still treat people like people even if they use. ❤
Ty to this gentleman for allowing me to view this so that I can learn to help.
I agree.
Almost had this done to me in March of 2020. Luckily my heart reset itself and I did not need that to be done to me. Trust the polyvagal theory and much love given to the subject in this video!
Carlo,
I doubt we have much more than you have, but teaching is what is so much fun. Based on the quality of your videos (and time required to make them), it's obvious you have the "teaching bug".
Would just like to say a huge THANKS for all of the videos that you post Dr Mellick! I am a junior Dr and I find these to be fantastic learning tools! Thanks again!
Excellent!
Thank you so so much for making these videos, there is only so much you can learn from text book/lectures.... actually seeing the procedure on video is really helpful... Thanks again, from the UK!
Very helpful to watch these viseos being a nursing student with a cardiac med surg exam next week! Thanks for posting!
I've never seen such a brave old man for this he's a superhero
+Donovan Alvarado ... You don't have much choice in a situation like that. The superheroes are the medical staff and "modern medicine". I ended up having ablation after quite a few emergency room visits and adenosine pushes. The last time (before ablation), it took two shots of adenosine; I never considered that one wasn't enough. So when the second one worked and I asked the doctor "what if that hadn't worked?" and he shrugged and said, "the paddles?", I said, "okay, enough is enough". I had ablation 10 years ago and even though the v-fib can happen (in another spot) someday, so far, so good!
Marcy RP ohh yeah I forgot about those! I thought we was dong it to be brqve
Welll..... I guess you COULD say "no", but that would be a lot braver (or dumber) to NOT do it, huh? LOL
+Marcy RP I would rather not do it
Haha....yeah, I'll bet HE wouldn't have either!
His heart was about to burst, but damn that blood pressure is super low
94/69 isn't even usually considered hypotension, though
Thank you! They are a great team.
Phenomenal. I love the pt's response when asked about filming the procedure.
Dang! No sedation! He took it like a Champ!!
They gave him Versed, he already doesn't remember it.
He really did, I was sedated for that procedure.
they can't sedate because the reason that high of heart rate is dangerous is due to the low blood pressure becuase the heart isn't really able to pump fully, fluid dynamics and stuff like that it's so if they sedated him his blood pressure would probably drop further which could kill the patient
Good Video. Only when you push the shock button remember to make sure to clear the table and make sure no one is in contact with the patient. It is also a good idea to look at the patient as you push the shock button just to make sure no one is too close. Really enjoyed this.
I have been troubled with SVT issues this past year. The highest was 223bpm possibly higher I’ve had issues with ectopic beats over the years and I learned to live with them but this recent development has been sudden. I was rushed into hospital several weeks ago because I had an SVT following a bad asthma attack. Probably due to the amount of salbutamol needed in the nebulizer to stabilise my breathing. Normally it will make my heart beat very fast but by the time paramedics arrived and had me hooked up to everything they started asking if I had a heart condition, so I said I have SVT issues and they said that I was having one. Initially I thought it was a mistake and they said no I became very dizzy. I thought I was going to pass out they said they needed to take me to hospital because my heart rate was sitting at 200bpm for half an hour. I tried to convince them to wait longer but they said no it was very dangerous! I was surprised because I didn’t think it was dangerous just uncomfortable to experience. They said they would have to use blue lights and not to be frightened by it but it was to make sure they got me to hospital faster. Normally it’s a half hour ride to the hospital. My heart rate was beginning to drop by the time we reached the hospital. The SVT often starts suddenly and disappears very quickly. It’s really weird and since that episode several weeks ago my heart is doing weird things. I haven’t slept much these past few days because constant ectopic beats and flutters are keeping me awake. It’s very uncomfortable and a lot of pressure sometimes pain in the chest neck and jaw. I can assure you that if I call a doctor they will ask things do I have any chest pain? The answer would be yes coming and going. Then they would immediately send an ambulance. The problem is I have other major medical conditions so I dread A+E I’m wheelchair reliant now so it’s extremely difficult to cope with. I will say that the paramedics have been hero’s and the nurses and doctors have been fantastic. I’ve been in and out lots this year for asthma and diabetes. They really are amazing! I am not a doctor so I have no idea why this is happening. I don’t know enough about it. The pain I’ve probably pulled a muscle again. Are these normal symptoms? It’s not usually frequent. I’m exhausted and just need to sleep 😴
Thank you Larry!! I was searching for a reallife emergency videos thanks a million !!
+me mo You are welcome. I hope you enjoy my channel.
+Larry Mellick i did enjoy it !! great job :)
I am having this procedure tomorrow morning at Peninsula Hospital south of Melbourne Victoria Australia. I am glad I watched this so I know what to expect. Doctor and nurse say, all good, no big deal but seeing it down is terrific. Thanks to the gentleman and the medical team.
Good luck!!
Thanks Dr. M. If I ever end up in the GRU Hospital I will ask for you by name!
Very impressed with your staff. He was obviously a difficult patient on many levels.
I understand. Must be a hard to watch people go through pain everyday. I dont know how you do it personally! You guys are angels in scrubs :)
Don't be afraid of cardioversion. I've had 5 within 13yrs. It took me out of trouble many times with arrythmias. I was sedated and didn't feel anything.
Lucio Castro well you probably don’t remember feeling anything haha. It’s almost fun cardioverting people when they’re sedated. They’re sleeping and then they start screaming and then go back to sleep
Don’t be so causal with it. There are risks and as you can see you return back to afib.
Barking Spider dude I ain’t a doctor. I just shadow er docs all the time and it’s fun watching the procedure. Chill
Ethan Jones I wasn’t talking to you. Learn youtube.
I have an AICD and I've been awake for every one of them. I'm glad they kept me alive but they are terrifying.
The doctors and nurses were so great. This is the type of care i would want if i were in this situation.
256 bpm!!!! hooooly shiiiit!!! ferrari-heart
B1oniK should be dead by now
Yep that's a Bugatti for a heart ❤️
I had 290 before my cardioversion. I was praying the whole time.
Pamela Dalton what the hell does that feel like? Must feel like it’s going to jump out of your chest.
I had a heartbeat of 250+ bpm last week. It HURTS! lol
Ive had this a few years ago under sedation. Got me fixed up, doung great. Great team of Drs. here. Hope paitient is doing well.
That's wild! I wasn't that bad when I had a Cardioversion done two years ago. Glad to see that he is alright!
I can't stop watching your videos, they are so freaking informative :)
Thanks for the video! Take my NCLEX-RN tomorrow and this was a great video for me to see how cardioversion works
Alison Wisehart You are welcome, Alison. Good luck!
Procedural sedation is generally safe, but these medications can lead to apnea. The oxygen is precautionary as is the end tidal CO2 monitor.
Hi Olga,
Yes, the emergency physician in this video determined that his blood pressure was low and didn't want to use the propofol that we commonly use. Versed was administered and I think pain medication was given. This combination isn't as effective and I think if we were to do this over we would take a little more time to look at other options that do not drop you blood pressure.
Larry Mellick nice. Thanks for the educational exprience
This happened to me. Zero risk factors. No history. Just happened one day. Went to ER and spent a night getting drugs to slow my heart rate down enough for cardioversion. Propofol, jolt, wake up, go home. Will likely never happen again.
i've had 12 cardioversions in 18 months, its awful.
Did you have a lot of caffeinated drinks?
But you are alive to us,so it's "good".❤
I went through a bad period of Afib through 2021/2022 and was cardioverted six times over eighteen months. It felt like I'd stepped into a Hell from which there was no escape. My heart rate would rise to typically between 140bpm and 180bpm. I thought that was bad, but what must it be like to be 250bpm? I don't think I'd be able to survive that.
One thing I do know is that the sense of relief, peace and calm after cardioversion is beyond my ability to fully describe, but, it's the best feeling in the world.
I still live with paroxysmal Afib, and awaiting catheter ablation, but in the meantime I learned to recognise the triggers that set it off, and some methods to get it back under control. Even so, I've still had episodes that can last as long as 36 hours, and can still be just as frightening.
I hope the chap in the video gets his relief from his heart condition.
Thanks for sharing.
Wow I have just found this channel it is amazing thank you
I hope he had a speedy recovery
I used to do these with cardiologists. Miss doing these and TEEs.
thanks doctor ! i am a 3rd year medical student i appreciate your videos
+Lighto Yagami Glad they are helpful!!
Thank you from a nursing student.
We did too. Unfortunately with his low blood pressure the team felt uncomfortable giving him stronger sedation medications.
Excellent!! Couldn't agree more. Thanks for the feedback.
PVCs and PACs are fairly normal. Long runs of rapid heart beats are not. Coffee, caffeine and probably stress and fatigue can increase their frequency.
I am addicted to your videos. So interesting and informative
Ashley Juvancic Cool!! Thanks!!
The nurses are amazing
great videos really appreciate,,,i have going to emergency department tomorrow for rotation and its great help...love you guys
I made 260 once. I feel this guy's pain
thats terrifying... highest ive had was 176 :/ and i thought that was bad
Sophie Harrington I had a pulse of 200 during my tonsillectomy back in 2011. I had a major bleeding event five days after the initial procedure in which I estimate myself to have lost about 35% of my blood.
254 here
Wow I thought I was dying with a 140 heart rate. This makes me feel better
Sophie Harrington Happened w me 3x!
I have an ICD which, unfortunately, doesn't deliver a sedative before deploying, lol. This condition is really scary for me. There is nothing I can do to control it at all. I cannot just take deep breaths or anything, well sometimes coughing can trick it, it either has to resolve itself or be "shocked" back into rhythm. I wish this gentleman a whole lot of luck and good health in the future.
Me too! I've had 2 shocks this year....there is stuff in my emotions i need help with.
Only Versed. Limited sedation medications decided by operator because of concern over recent low blood pressure.
At 230 I can still get myself into the ER at 255 it’s lights out. Every time you think, this is it.
Brave man,heroic staff.
Thank you very much for that info!, I will deff check into it. I will be learning from Dr M , and his helpful and informative vids could very well save a life. Thanks ~
Got both. The last event was cardioversion.
It looks like the chest pads for the cardioversion, the monitor leads and the EKG 12 lead.
Also glad to see that someone other than me, Jake Adams, knows that Oxygen does not burn. It simply supports combustion at a higher rate than the normal air we breathe.
Saw this done when I was 14 as an explorer on an ambulance. No sedation at all. It was pretty cool
No mention by any staff member of giving the patient any pain medication.
Nice Video Dr Mellick, thank you so much for sharing it! I'm a nurse working on ambulance in italy, i have two question about this video: the first is: I know that the BP was too low and propofol was not indicated, why you didn't use a small bolus of benzos such as midazolam? And why provide high flow o2 with reservoir ? was the patient hypoxic befor the cardioversion or what? Thank you so much for any information!
No that would not be normal. However, I don't think it was immediately obvious to us in the room.
Paramedic here. Wasn't the AHA recommended starting dose for synchronized cardioversion 50J in 2012? I'm not criticizing the treatment, just respectfully here to learn. Thanks for all of your videos, Dr. Mellick! I recommend them to my paramedic students.
m2inla I'm a Paramedic also. I agree. Also aren't you supposed to turn the O2 off during cardioversion?
My partner’s driving and New Orleans’ streets once converted an SVT for me. Pt was tach-ing along at 200 and I was in back preparing to start my IV and give her adenosine when he hit a bump hard. She momentarily came up off the stretcher (yes she was strapped in but not tight) and when she slammed back down she converted to sinus rhythm.
I love your educational videos.
I agree with you Dr. Mellick. I watch you both, and I have learned so much from you both. I think Dr. Oller is well versed and does his research thoroughly. I believe he would be a fantastic teacher. He really already is through his videos. I admire you both. I get to see things that I don't get to see working in the environments that I work (now it is private duty), so I find it fascinating. My husband finds it gross and almost throws up...lol!!!
Yes you can, you just have to place one paddle 3 inches away from the pacemaker battery and the other a little lower on the ribs than you would usually do. By all means don´t put the paddle ON TOP of the battery. You could short circuit it and the patient would need to get a new one. But I tend to think they prefer to be alive and need a pacemaker change than dead with a perfectly working device.
It's probably safe to do with modern pacemakers...
Manegold JC et al. External cardioversion of atrial fibrillation in patients with implanted pacemaker or cardioverter-defibrillator systems: A randomized comparison of monophasic and biphasic shock energy application. Eur Heart J 2007 Jul; 28:1731-8.
My dad just had this done yesterday morning 12hrs after his Heart Cath procedure. His heart was at 203bpm & BP was 70/40. They could only give 1mg of versed due to his low bp. He said it felt like he got kicked in the chest, seen flashing of a white light & swore he had burn marks on his chest. Thankfully he is back in normal sinus rhythm but now has to wear a life vest for 3 months in case of another episode.
Thanks drs and patient
Do they ever try to submerge the patients face in ice water? That would trigger the dive reflex and slow the rate down. I worked in an ER and we did this successfully with a pregnant woman.
No that wasn't tried.
That shock seemed brutal. I was admitted into the hospital bc my heart rate was up in the 200. I wasn’t in any pain. They gave me 2 doses of some meds that made me feel like a horse was sitting on my chest. Then my heart rate decreasing back to the normal rate. The diagnosis was Super ventricular tachycardia.
SVT with suspected ANVRT.... If vasovagals and adenosine fail, sync shocks won't. Always satisfying to see that heart rate and BP plummet back into normal ranges.
But why was 100J used on the first shock? Normally we would start with a 50J shock.
Nice job.
I’ve got to have one of these with a TEE I’m having done in early June in about ten days.
Great video! I wanted to ask if ketamine would have been preferable to versed considering the patient's hypotension but I forgot it could exacerbate his tachycardia.
Followed!
+Randal Perryman Thanks!
love the videos.. but i am trying to figure out why PPE is not being worn. As in gloves and you are touching the patient?
Donald Youngman
Because they're nurses.
+Donald Youngman unless there are body fluids visible you won't bother with that whole your patient's ready to code on you.
Thanks for the info! I am new to tYT,didn;t understand in what capacity he was in these hospital, hospitals. I went to his channel but I am not very good at this YT stuff. At least now I understand why he is allowed to film all these incidents. and be able to help other people. I found his video when I was looking at a poor fellow with dry socket after tooth extraction. And I have been here for about 5 hours now!!! lol STILL looking for info on those injections he does for headache/facial pain!
12 years ago?!! Is he still alive?! I hope so he is amazing person may he soul be in peace
Just had this done today, I got sedation but was still aware. It worked. Technology is amazing.
at 0:46 he says "6, then 12 of adenosine. We did 24 along with vagal maneuvers". 24 of Adenoside or b-blocker..?
They gave him a small dose of sedation but not too much bc of the low blood pressure.
could have given him ketamine. we use that here in the south of England on our critical care trucks
i think ketamine alters you K+ maybe a chem8 on iv start
Snap Quartimon ketamine would raise his HR which was already high
no sedation because blood preassure low. . u see monitor show b/p 88/67 and 82/63
thanks for teaching us))
You're welcome!
Larry Mellick
That would be highly unlikely, but it is a scary thought.
dr mellick was this patient given emergency cardioversion and did work on this patient and was seen by cardiology in this case was his blood pressure low
This was done to me a late July 2015 in an ambulance, but without sedation and all the preparation.
I have a defibrillator implanted. One day my heart rate got so high that my defibrillator fired twelve times. It was not pleasant. I was in sinus rhythm for a month, but now I'm back in AFib and it sucks.
Most NON-Critical Care Transport teams and non-helicopter transport teams do not carry propofol. Would you recommend doing valsalva & what is the "decision point" you would recommend that the paramedics begin emergency cardioversion, i.e., if they are 10 min out, 20 min out, in the patients living room? I had a guy CAO with V-tach and the hospital was 5 min out. Asymptomatic. I left him alone/load&go. Do you agree? What post instructions did the other guy give besides Ativan? Strong accent.
Thank you so much! Appreciate.
You are welcome.
It means he's probably in DT's, or about to experience them, or so I'm assuming they meant by stopping alcohol (EtOH). Plus I believe I heard them order Ativan and a banana bag - another indication that they're trying to control or prevent symptoms of alcohol withdrawal...
My unit routinely uses Levophed before cardioversion if the pressure falls either due to the tachycardia itself or to counteract sedation-induced hypotension. This would have allowed you to use full sedation. Perhaps there was a reason you guys didn't want to use pressors, but to each their own.
u can sedate with etomidate if u don't want to admin propofol or midazolam by the BP.
255BPM SOLID WITHOUT A CARE WHAT A TANK!!
awesome videos! Thank You Doc! :D
+Lizzie Ferr Thanks Lizzie!
Larry! Love these videos. It would be awesome to do a video about you and your experience and maybe some "pearls" to emergency medicine. I love watching these as a medic. Why no Ketamine though? I know it's a fairly "new" (not new at all) medicine to old school providers. But it could've been valuable here I would imagine. Thanks for your input Dr. M!
Thanks, Michael. I wasn't the operator, but ketamine would possibly have been acceptable. I don't remember from 2012 why the decision was made to go without it.
Larry Mellick Thanks! I guess I failed to see the date of video as well. Although it's been around and used by many providers, it's a new "hot topic" drug now. Especially as it's been integrated into EMS and DSI is becoming more popular than RSI. THANKS AGAIN! You rock! LOVE these videos. Sometimes I make my shift mates watch them when they pertain to EMS and we discuss Benifits and risks of the videos we see. Have a great day!
I had ketamine this week for a cardioversion. It sent me on a trip; I thought I was dying!
khd2005 what exactly happened? There's a known risk called emergence syndrome. Causes psychotropic dreams from what o hear. I've also read a seemingly valid study that gave a little versed once hemodynamically stable and it put a kibosh on the emergence syndrome dreams/nightmares. It's a very safe drug in that almost every other drug for sedation drops blood pressure (which is bad bad bad for cardioversion or any cardiac procedure) and also decreases your respiratory drive. Thus... most providers are willing to compromise on wicked/vivid dreams.
My veins felt painfully constricting and oxygen affected at 165. How is the pt so chill??? Let alone at 236!!
After some point you don't even feel your heart beating. Just a little uncomfortable.
@peacenow42I know that electric feeling you mean - it's like pins and needles, actually worse... and without the prickly feeling - just the vibrating kinda feeling. It's literally the feeling of no oxygen getting to our extremities, slowly moving up our limbs, towards the rest of our body... and it's bloody terrifying!
@peacenow42 That is interesting indeed! This sensation is rather still new to me, as I have only started experiencing it the past 8 months or so and I do not see it getting any better, unfortunately. I do recall my face and forehead get this numbness and tingling kinda feeling before the extremities start getting that electric feeling. Those long pauses must definitely not be a fun experience for you, poor thing!!! I can only imagine because 2 seconds seems like forever for myself. And when you say it eventually gets peaceful, that thought itself is terrifying!!! Literal fight or flight mode.
Just got discharged for an SVT. Granted I’m 23. But my HR hit 242 and I was walking around well enough to call for help. Rapid response team looked at me like I was crazy. Not a fun feeling, you feel like your heart is about to burst out your chest
I remember going upwards of 220 before an in office surgical procedure about 12 years ago. I was very anxious about the sedation and that was why my heart rate was going that high. I just felt the anxiety mostly, very little chest discomfort. I asked the attendant if it was safe to be sedated at that heart rate and she said no problem and put me to sleep lol.
Kinda late to the party. But are the limb leads flipped with the positive deflection in Avr?
NICE! wide complex v- tach cardioversion! what really sucks is when they dont convert and begin to lose consiousness then the real fun begins!
Next time I want this treatment, instead of waiting for hours on end while my heart goes bonkers.