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
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.
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.
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 😴
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. ❤
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.
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
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!
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.
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.
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.
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.
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!
@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.
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.
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!
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.
+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!
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.
Said that he just stopped ETOH? Do you mean he was an alcoholic and had just stopped? No wonder this poor man was so rough... My father was a pretty severe alcoholic to the point of having liver damage, and he detoxed severely once in jail. My mother said it was HORRIBLE. He was out of it, called her by someone else's name. Thought that he was sailing on a ship.. It was insanity. So no wonder this guy's ticker suddenly went tits-up.
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".
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..
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.
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.
Being shocked without a sedative is fucking hell, 0/10 would not recommend that shit hurts like a bastard i wasn't even sedated at all and ems hit me in my living room floor, wasn't even svt it was afib rvr. Fucking sucked.
Fk I was about to say they didn’t even sedate the poor guy.. I hope he survived the outcome of his hospital visit. ❤ I have only ever seen this done medically and the pt groaned and grabbed his chest and his rhythm stabilised.
Why the hell don't they sedate him? Low blood pressure can be handled. And because he has VT, the blood pressure is low. Once you get it back to sync the pressure will rise. I'm an ER doc myself, and I've done countless cardioversions. But not once while the patient is awake. Wow, not nice at all.
Looked more like SVT to me, there was no AV dissociation and it was narrow-complex. You're probably right about his hypotension being associated with his tachycardia though. Sounded like they did give some Versed; I wonder if they also gave Fentanyl
Looks like they hit him with an amnesic dose of Midazolam...he'll jump and respond to the conversion but it's unlikely he'll remember it. All things being equal, if he didn't remember it, he didn't feel it.
they gave him Versed. That nurse mumbled that she gave it and seemed annoyed that at least 2 people confirmed whether it was given or not. Overall it didn’t look like good team dynamic.
just a note, our prehospital collaborative protocols state never to delay cardioversion with unstable svt (cardio-resp. compromise, low BP) for pain rx. I would however at minimum give IM versed or fentanyl if no immediate IV access prior. I also did hear Versed adm mentioned prior to cardioversion in video.
I asked the other day about the necessity of propofol for this procedure. It was apparent that he did get a big hit in the chest as described by the cardiac guy. I also heard the comment about sedation and his hypotension. I guess after seeing this cardioversion vs the woman with the propofal that I might want some medicine if indicated! LOL! It truly did look like a baseball bat to the chest.
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.
How would ketamine work Larry? I am taking it that he presented himself at the ED 4 times over 4 days and valsalva worked and he was discharged? He did not want to do ETOH detox or referral was not made before? If paramedics arrived on the scene with the guy just like this, with the monitor at .24 shown here. Lets say they are out of range of hospital communication. With his BP there are limited options. Adensosine no. Would you get mad if the medics did it on scene same the way.
This is a repulsive cardioversion. The doctor is smiling as this was some big joke, if it's nerves then pass the responsibility onto someone else. There's no pillow under the patient's head, and then telling the patient it's going to feel like a baseball bat hitting his chest. You didn't sedate him completely..."you didn't sedate him at all!" His MAP is 80mmHg that's not low. You already injected Adenosine and Versed and his BP was acceptable. I don't ever want to go to this ER.
Poorly sedated, and if the haemodinamical unstability was the issue, should at least have tried with some fentanyl, it blunts nicely the baseball bat discharge upon his chest and it doesnt compromise seriously the blood pressure, besides he had a high flow O2 device on.
Stopped EtOH? Does that mean what I think it means? O_o Also, I'm curious; the Wikipedia page on AVNRT has an ECG tracing, but it doesn't look right to me; I'd describe in more detail, but I'm afraid of being labeled a smart-ass. :P
Maybe I do not understand in this but I was wondering . I saw other videos about same thing but the patients recived some kind of drug to sleep during it. Is that means means that not everyone can recive this when trited this way?
oxygen is not flammable! it is an oxidizer that promotes burning however it will not burn on its own. if there was a fire then maybe risky however with defibrillation pads the risk of even a spark is very minimal
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.
why they didnt give him propofol before cardioversion or midazolam, of course he had hypotension because of hemodynamic instability and rapid heart rate
![Cody Johnson - I'm Gonna Love You (with Carrie Underwood) [Official Music Video]](http://i.ytimg.com/vi/yy9PuYMU29g/mqdefault.jpg)
Patient laying there with heart rate 255 and looking very healthy.... crazy! Good to see he is ok now
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
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.
At least the nurse was completely honest with him telling him it’s gonna hurt like hell for a second
His heart was about to burst, but damn that blood pressure is super low
94/69 isn't even usually considered hypotension, though
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.
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
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 🤣
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 😴
As a nursing student watching videos like this is really helpful! Thank you!
Cool! I am glad they are helpful!
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. ❤
Procedural sedation is generally safe, but these medications can lead to apnea. The oxygen is precautionary as is the end tidal CO2 monitor.
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".❤
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.
255BPM SOLID WITHOUT A CARE WHAT A TANK!!
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!
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!
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.
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
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.
Thank goodness for modern medicine and these excellent doctors.
I used to do these with cardiologists. Miss doing these and TEEs.
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!
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.
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.
Big thank you to the gentleman letting us see this procedure. Very interesting and educational!
Good! Glad it was helpful.
Ty to this gentleman for allowing me to view this so that I can learn to help.
I agree.
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!
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.
thanks for teaching us))
You're welcome!
Larry Mellick
why they did not give him O2 immedietly to decrease O2 demand with that tacchycardia ???
+ن.م If we didn't, we probably should have. Good suggestion.
+Larry Mellick thank you for your answering
Not seen SYNC on
Thank you! They are a great team.
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
He was already hypotensive. He received some Versed to at least relax him just enough.
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!
at 0:46 he says "6, then 12 of adenosine. We did 24 along with vagal maneuvers". 24 of Adenoside or b-blocker..?
Very helpful to watch these viseos being a nursing student with a cardiac med surg exam next week! Thanks for posting!
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.
Said that he just stopped ETOH? Do you mean he was an alcoholic and had just stopped? No wonder this poor man was so rough... My father was a pretty severe alcoholic to the point of having liver damage, and he detoxed severely once in jail. My mother said it was HORRIBLE. He was out of it, called her by someone else's name. Thought that he was sailing on a ship.. It was insanity. So no wonder this guy's ticker suddenly went tits-up.
His hands were "blue" after the procedure. Is that normal?
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".
We did too. Unfortunately with his low blood pressure the team felt uncomfortable giving him stronger sedation medications.
Only Versed. Limited sedation medications decided by operator because of concern over recent low blood pressure.
why is the oxygen on during cardioversion??
No that would not be normal. However, I don't think it was immediately obvious to us in the room.
It looks like the chest pads for the cardioversion, the monitor leads and the EKG 12 lead.
Propofol causes hypotension and would make a low BP seriously worse.
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..
it looks like VT from the screen with a rate of 235 as well
Good video, but the individual pressing the shock button NEEDS to make sure everyone is clear before multiple patients develop.
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.
Thanks! Okay, I'll see what trauma video I can come up.
That would be highly unlikely, but it is a scary thought.
Excellent!! Couldn't agree more. Thanks for the feedback.
The nurse in the lilac scrubs needs to put her gloves on! Grabbing his arm that was bleeding with no gloves.......>:-(
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.
Great video but this is ER situation, put on gloves
sorry but...HYPNOMIDATE or midazolam?!?!?!?!?!? are you crazy?!?!?
Got both. The last event was cardioversion.
I had 183 bpm Tuesday and have SVT and palpitations. I can't imagine 256!
no sedation because blood preassure low. . u see monitor show b/p 88/67 and 82/63
Being shocked without a sedative is fucking hell, 0/10 would not recommend that shit hurts like a bastard i wasn't even sedated at all and ems hit me in my living room floor, wasn't even svt it was afib rvr. Fucking sucked.
Fk I was about to say they didn’t even sedate the poor guy.. I hope he survived the outcome of his hospital visit. ❤
I have only ever seen this done medically and the pt groaned and grabbed his chest and his rhythm stabilised.
Saw this done when I was 14 as an explorer on an ambulance. No sedation at all. It was pretty cool
Just had this done today, I got sedation but was still aware. It worked. Technology is amazing.
We do it in Germany after having administered a painkiller and a hypnotic😊.
Why the hell don't they sedate him? Low blood pressure can be handled. And because he has VT, the blood pressure is low. Once you get it back to sync the pressure will rise. I'm an ER doc myself, and I've done countless cardioversions. But not once while the patient is awake. Wow, not nice at all.
Looked more like SVT to me, there was no AV dissociation and it was narrow-complex. You're probably right about his hypotension being associated with his tachycardia though. Sounded like they did give some Versed; I wonder if they also gave Fentanyl
Looks like they hit him with an amnesic dose of Midazolam...he'll jump and respond to the conversion but it's unlikely he'll remember it. All things being equal, if he didn't remember it, he didn't feel it.
they gave him Versed. That nurse mumbled that she gave it and seemed annoyed that at least 2 people confirmed whether it was given or not. Overall it didn’t look like good team dynamic.
just a note, our prehospital collaborative protocols state never to delay cardioversion with unstable svt (cardio-resp. compromise, low BP) for pain rx. I would however at minimum give IM versed or fentanyl if no immediate IV access prior. I also did hear Versed adm mentioned prior to cardioversion in video.
I agree with u 1000%. I have never done a cardioversion to an awake patient. Low blood pressure could be managed with IV fluid or neosinefrine.
Not VT, probably just the view.
I'm sorry.. TWELVE ADENOSINES?!?? 😭😭😭
My cardioversion results lasted thirty minutes!
why the pt seems alert when HR @256, but confused when HR drop to 120?
how terrifying but how impressive.
12 years ago?!! Is he still alive?! I hope so he is amazing person may he soul be in peace
I asked the other day about the necessity of propofol for this procedure. It was apparent that he did get a big hit in the chest as described by the cardiac guy. I also heard the comment about sedation and his hypotension. I guess after seeing this cardioversion vs the woman with the propofal that I might want some medicine if indicated! LOL! It truly did look like a baseball bat to the chest.
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.
How would ketamine work Larry?
I am taking it that he presented himself at the ED 4 times over 4 days and valsalva worked and he was discharged? He did not want to do ETOH detox or referral was not made before?
If paramedics arrived on the scene with the guy just like this, with the monitor at .24 shown here. Lets say they are out of range of hospital communication. With his BP there are limited options. Adensosine no. Would you get mad if the medics did it on scene same the way.
This is a repulsive cardioversion. The doctor is smiling as this was some big joke, if it's nerves then pass the responsibility onto someone else. There's no pillow under the patient's head, and then telling the patient it's going to feel like a baseball bat hitting his chest. You didn't sedate him completely..."you didn't sedate him at all!" His MAP is 80mmHg that's not low. You already injected Adenosine and Versed and his BP was acceptable. I don't ever want to go to this ER.
Forget the Versed, Ketamine please!! He needs a banana bag for sure and maybe some more benzos for the withdrawal!
I think I counted 26 electrodes...
Not a comment on the care, just thought it was funny to see that many.
Poorly sedated, and if the haemodinamical unstability was the issue, should at least have tried with some fentanyl, it blunts nicely the baseball bat discharge upon his chest and it doesnt compromise seriously the blood pressure, besides he had a high flow O2 device on.
Hah, not much, though.
Stopped EtOH? Does that mean what I think it means? O_o Also, I'm curious; the Wikipedia page on AVNRT has an ECG tracing, but it doesn't look right to me; I'd describe in more detail, but I'm afraid of being labeled a smart-ass. :P
Maybe I do not understand in this but I was wondering . I saw other videos about same thing but the patients recived some kind of drug to sleep during it. Is that means means that not everyone can recive this when trited this way?
oxygen is not flammable! it is an oxidizer that promotes burning however it will not burn on its own. if there was a fire then maybe risky however with defibrillation pads the risk of even a spark is very minimal
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.
why they didnt give him propofol before cardioversion or midazolam, of course he had hypotension because of hemodynamic instability and rapid heart rate
You just answered your own question
You are welcome.
Quite Welcome!
NICE! wide complex v- tach cardioversion! what really sucks is when they dont convert and begin to lose consiousness then the real fun begins!
Stay with Larry Mellick to lear a lot. Also look for edexitvideo on RUclips. Dr. Carlos Oller in Jacksonville has a good channel on RUclips.
its not normal no. Anxiety can cause very similar symptoms as a heart attack. See your doctor and also find ways to relax and get some exercise.
I agree!
Why the oxygen was not removed temporarily to avoid possible combustion or with a fire that could cause electrical arcing?
Thanks!!
Thanks!
MD
Thanks!
can you cardiovert a patient who has a pacemaker? i heard theres a chance it could damage the generator....
is it normal to have heave heart beats through out the day? can anxiety cause this?
oh my goodness I felt so bad for him! :(