1. The document discusses cardiac arrest and the differences between defibrillation and cardioversion. It presents a case of a 60-year-old male patient who experienced sudden cardiac arrest due to pulseless ventricular tachycardia.
2. Key points from the literature review include that defibrillation is used to treat shockable rhythms like ventricular fibrillation and pulseless ventricular tachycardia during cardiac arrest. Cardioversion is used to treat tachyarrhythmias with a pulse like atrial fibrillation and atrial flutter in a synchronized manner.
3. The document reviews defibrillation and cardioversion techniques including energy levels, paddle positioning, algorithms for treatment, and complications. It emphasizes
Cardiac arrhythmias occur frequently in ICU patients.
12% incidence of ventricular plus supra ventricular arrhythmias for a general icu population.
The most common arrhythmia is sinus tachycardia. Atrial arrhythmias also occur with some frequency , where as ventricular arrhythmias are less common but usually more ominous.
Not all arrhythmias seen in the ICU are of new onset , some patients have preexisting arrhythmias that can be exacerbated by their critical illness
Cardiac arrhythmias occur frequently in ICU patients.
12% incidence of ventricular plus supra ventricular arrhythmias for a general icu population.
The most common arrhythmia is sinus tachycardia. Atrial arrhythmias also occur with some frequency , where as ventricular arrhythmias are less common but usually more ominous.
Not all arrhythmias seen in the ICU are of new onset , some patients have preexisting arrhythmias that can be exacerbated by their critical illness
ventricular premature complexes and idioventricular rhythm identification is important in the ICU ..they may run into arryhthmias..look over my seminar...
any queries...
Myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. Find a good presentation on Acute myocardial infarction here.
ventricular premature complexes and idioventricular rhythm identification is important in the ICU ..they may run into arryhthmias..look over my seminar...
any queries...
Myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. Find a good presentation on Acute myocardial infarction here.
Acute type A dissection, is on of the highest mortality cases in cardiovascular surgery. It doubled it incident with concomitant complication such as malperfusion or pericardial tamponade. In this presentation, the patient have both coronary malperfusion and pericardial tamponade
EMGuideWire's Radiology Reading Room: Stress-Induced CardiomyopathySean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Stress-Induced Cardiomyopathy and is brought to you by Jenna Pallansch, MD, Claire Lawson, NP, Shelby Hixson, PA, Emily Lipsitz, PA, Ashley Moore-Gibbs, DNP, Laszlo Littmann, MD, and John Symanski, MD.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. Cardiac Arrest
An Overview of
Defibrillation v/s Cardioversion
PRESENTER
Dr Muhammad Umair Shafique
HOUSE OFFICER
SKBZH/ AK CMH MZD 2
SUPERVISOR
Dr Babar Bilal
Consultant Cardiologist
SKBZH/ AK CMH MZD
5. • 60 yrs old male, known case of IHD
• Brought into the ER by his attendants in unconscious
state
• Apprehension
• Drowsiness for last 3 hours
• Followed by unconsciousness
8
BRIEF HISTORY
6. • Discharged from hospital one day ago after MI (being
late for SK)
• He experienced sudden apprehension and drowsiness
followed by unconsciousness
• Chest pain
̊̊̊̊ , palpitations
̊̊̊̊ , SOB
̊̊ , fits
̊̊ and urinary
incontinence
̊̊
9
HOPI
7. • Was found to be PULSELESS and CPR was started
1
0
EXAMINATION
Blood Pressure 80/ 60 mmHg
Resp Rate Gasping
Temp Afebrile
Oxygen Saturation 80% at Room Air
Blood Sugar Random 90 mg/dl
9. • Diagnosis
SUDDEN CARDIAC ARREST Secondary to
PULSELESS VENTRICULAR TACHYCARDIA
• Pt was immediately defibrillated
12
MANAGEMENT IN ER
10. 1
3
POST DEFIBRILLATION ECG
• Rate: 90
• Rhythm:
– R-R: Regular
– P-wave: Present
– No AV Dissociation
– Normal QRS
– ST elevations in Inf leads
11. • Pt was shifted to CCU
– Inj Heparin IV 5000 units ×stat
– Inf Heparin IV 1000 units/ Hr
– Inf Dobutamine IV at 10-12 micro drops/ min
• Titrated against B.P
– Tab Lowplat Plus 75/75 mg PO ×OD
– Tab Rosuvastatin 20 mg PO ×HS
– Cap Omeprazlo 40 mg PO ×OD
14
TREATMENT IN HOSP
12. • 2D-Echo showed
– Proximal 2/3rd Inf, lat and post wall hypokinesia
– 40-45% EF
• Was discharged on 5th day of admission and referred for
PCI to higher cardiac center
15
FOLLOW UP
14. • Death following Sudden Cardiac Arrest (SCA)
• Sudden Cardiac Arrest (SCA)* is the sudden cessation of
mechanical cardiac activity making the person
unresponsive, with no normal breathing and no signs of
circulation
• SCA restored spontaneously or by CPR/ defibrillation is
called Aborted Sudden Cardiac Death
*American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS)
17
CARDIAC ARREST VS DEATH
18. • An act of administering a transthoracic electrical
current to a person experiencing dysrhythmias
• Brief history
– 1899 – Discovery of defibrillation
– 1947 – First successful defibrillation
– 1965 – Portable defibrillation
2
1
CARDIAC DEFIBRILLATION
25. • Defibrillation is an A-SYNCHRONOUS random
administration of shock during a cardiac cycle
• It is administered in case of cardiac arrest due to
shockable rhythms
2
8
DEFIBRILLATION
27. • Cardioversion is a synchronized administration of shock
• In synch with the R waves or QRS complex
• Two types
1) Emergency Cardioversion
2) Elective Cardioversion
3
0
CARDIOVERSION
28. 3
1
RHYTHMS FOR CARDIOVERSION
1) Supra Ventricular Tachycardia (SVT)
AVRT and AVNRT
2) Atrial Fibrillation
3) Atrial Flutter
4) VT with Pulse
5) Any re-entrant tachycardia with un-stability
AVRT
ATRIAL FIB
ATRIAL FLUTTER
32. 35
ANTERIOPOSTERIOR POSITIONING
• Back of chest between tip of the left
scapula and the spine
• More effective in setting of
• Atrial fibrillation
• Implantable devices
33. Rhythm Monophasic (J) Biphasic (J)
Atrial Fibrillation 200 120-200
Atrial Flutter 100 50-100
VT with Pulse 200 100
Pulseless VT and V Fib 360 120-200
36
ENERGY SELECTION
In emergency, go for the MAXIMUM
34. • For Defibrillation and Emergency Cardioversion
– Desired rhythms
• Inj Heparin 1cc IV Stat in case of Atrial Arrhythmias
37
EMERGENCY PREPARATION
35. • Prior to cardioversion
a) Stop digoxin 48 hours before the procedure
b) Base line investigations (like Serum Electrolytes, TFT etc
to rule out reversible cause)
c) 2D-Echo to rule out any intra cardiac clot
d) Anticoagulation for 3-4 wks
38
ELECTIVE PROCEDURE PREPARATION
36. • At the time of cardioversion
a) Written and informed consent
b) NPO for 8 hours
c) Afebrile
d) Remove dentures
e) 12-lead ECG
f) Peripheral venous access
g) Attach Oxygen
h) Airway equipment and emergency trolley on stand-by
39
ELECTIVE PROCEDURE PREPARATION
40. 4
3
DEFIBRILLATION ALGORITHM
PATIENT RECEIVED IN ER WITH HEMODYNAMIC COMPROMISE
CHECK FOR PULSE
NO PULSE
START CPR & CHECK RHYTHM
SHOCKABLE RHYTHM
DEFIBRILATE IMMIDIATELY
CONTINUE CPR FOR 2 MINUTES AND REASSESS
41. 4
4
EMERGENCY CARDIVERSION ALGORITHM
PATIENT RECEIVED IN ER WITH HEMODYNAMIC COMPROMISE
CHECK FOR PULSE
PULSE PRESENT
CHECK RHYTHM
UNSTABLE TACHYARRHYTHMIAS
CARDIOVERT URGENTLY
REASSESS
44. POST CARDIAC ARREST ALGORITHM
RETURN OF SPONTANEOUS CIRCULATION (RCOS)
OPTIMIZE VENTILATION AND OXYGENATION
TREAT HYPOTENTION
GET 12-LEAD ECG
ST ELEVATIONS 2 MINS POST DEFIBRILLATION
TREAT AS MI
ADVANCE CRITICAL CARE
46. • Time is MYOCARDIUM
• Start CPR in 10 seconds
• Defibrillate only the shockable rhythms
• Clear the pt before delivery of shock
• Continue CPR 2 mins post defibrillation
• Initiate Post cardiac arrest care immediately after ROSC
49
TAKE HOME MESSAGE
47. • Topol, Manual of Cardiovascular Medicine, 4th Edition
• Manual of ACLS
• Internet resources for videos
50
RESOURCES
I Muhammad Umair Shafique, welcome you all to today’s CPC. The topic for todays discussion is Cardiac Arrest An Overview of Defibrillation v/s Cardioversion, that a\has been prepared under the
A WCT
A WCT
A WCT
A WCT
My pt a 60 yr old male known case of IHD was Brought into the ER by his attendants in unconscious state with history of Apprehension, Drowsiness Followed by unconsciousness for last 3 hours
Pt was in usual state of health, was discharged from hosp one day ago after infro-posto-lat wall MI being late for SK. While sitting comfortably at home he developed sudden apprehension and drowsiness followed by unconsciousness. There was no history of Chest pain̊̊ , palpitations̊̊, SOB̊, fits̊ and urinary incontinence. He was trf immediately to hosp on ambulance
On arrival in ER pt was assessed immediately and Was found to be PULSELESS and CPR was started immediately as per ACLS guidelines. He was afebrile with a blood pressure of 80/60 was gasping with an oxygen saturation of 80% at room air
A 12 lead-ECG was obtained immidiately showing ventricular tachycardia
Based upon history, short examination and ECG findings a diagnosis of SUDDEN CARDIAC ARREST Secondary to PULSELESS VENTRICULAR TACHYCARDIA was made.
Pt was immediately defibrillated and reverted back to normal SR
This was the post defib ECG where you can see that the rhythm has reverted back to normal SR. Pt regained consciousness and became vitally stable. Please take a note of these ST elevations in inferior leads post defibrillation, I shall talk about them in the end.
Post cardiac arrest care was initiated immediately and pt was shifted to CCU on following treatment.
Pt remained stable and improved clinically, the 2D-Echo done on next day showed, Normal sized cardiac chambers , with proximal 2-3rd Infro-posto-lateral wall hypokinesia, an EF of 40-45% and Mild MR, pt was discharged on 5th day of admission and referred for PCI to higher cardiac center
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AHA defines SCD as the Death following Sudden Cardiac Arrest (SCA)
While SCA is the sudden cessation of mechanical cardiac activity making the person unresponsive, with no normal breathing and no signs of circulation
SCA restored spontaneously or by CPR/ defibrillation is called Aborted Sudden Cardiac Death
Rhythms in cardiac arrest may be
Shockable like VF and VT
And non-shockable like PAE and asystole
The causes may be cardiac or non cardiac. Cardiac causes include CAD which accounts for more than 80% of SCD Followed by Cardiomyopathies and Structural Heart Disease. Cardiac tamponade is the main cause of SCD in the setting of chest trauma
Non cardiac causes include epilepsy, Massive pulmonary embolism, severe Asthma and electrolyte imbalances
This animation shows the normal electrical activity of heart coupled with mechanical activity. As you can see that being the pacemaker the SA node generates the current that travels across both the atria, It then relays in the AV node from where it travels down via bundle of His and bundel branches and is finally distributed to whole of ventricle via Purkinji Fibers. In the event of an MI, the effected area TAKES OVER the SA node causing arrhythmias like VT as shown in this animation
Cardiac defibrillation is An act of administering a transthoracic electrical current to a person experiencing dysarrhythmias. This depolarizes the whole myocardium and resets the pacemaker activity of SA node.
Defibrillation was discovered in 1899, while in 1947 first successful human defibrillation was done and
In 1965 portable defibrillator devices were made
They dramatically revolutionized the realm of cardiac resuscitation
When shock is delivered
the current traverses the myocardium
heart cells depolarize simultaneously
any abnormal electrical rhythm is terminated
SA resumes the NORMAL PACEMAKER ACTIVITY
So the when heart goes into VF
Defibrillation is done
And sinus rhythm is restored JUST LIKE THAT
The electric shock can be delivered in two modes that are
MONOPHASIC and BIPHASIC
Monophasic Current as evident by this animation is Unidirectional, less consistent, has low success rates and requires more ENERGY
While biphasic Current is bidirectional, more consistent, has high success rates and requires less amount of ENERGY
Based upon the SYNCHRONICITY OF ELECTRIC SHOCK WITH THE R-WAVE, there are two types of shock Defibrillation and Electrical Cardioversion
Defibrillation is an A-SYNCHRONOUS random administration of shock during a cardiac cycle not in synch with the R wave
It is administered in case of cardiac arrest due to shockable rhythms
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Cardioversion is administration of shock in synch with the R waves or QRS complex
Emergency cardioversion is for hemodynamically unstable tachyarrhythmias while Elective cardioversion is for stable tachyarrhythmias
Unstable tachyarrhthymias needing cardioversion include
This figure correlates the electrical activity of heart with the phases of cardiac cycle.
At the peak of R wave, myocardium is in ABSOLUTE REFRACTORY PERIOD thus no arrhythmias can be induced by external stimulations. Synchronization of the external current with R wave avoids energy delivery near the apex of the T wave, which coincides with a vulnerable RELATIVE REFRACTORY PERIOD for induction of life threatening arrhythmias
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In anterolateral position, one paddle is placed in Left 4th or 5th ICS on the mid axillary line while the other is placed on Right of the sternal edge on the 2nd or 3rd ICS below clavicle
In anteroposterior positioning, the left paddle stays in the same position while the other one is placed on the back of the chest between tip of the left scapula and the spine. This is more effective in setting of atrial fibrillation as atria lies in proximity of post wall of chest ensuring maximum delivery of current and in Patients with implantable devices shunting the current away from those devices
Here is the energy selection for various arrhythmias however for emergency situations, rule of thumb is to go for the maximum level of energy.
For defibrillation and emergency cardioversion, all you need is a shockable rhythm, no other preparation is needed as such.
A stat shot of 1cc IV heparin should be given simultaneously.
Cardioversion should be done in CCU setting. Written and informed consent must be taken, pt must be NPO for 8 hours, he should be Afebrile and not wearing any dentures. A 12-lead ECG be obtained to confirm the rhythm. Supplemental Oxygen and cardiac monitor must be attached and Peripheral venous access be secured. Airway equipment and emergency trolley must be on stand-by in case of any untoward complication.
