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Maternal Cardiorespiratory Arrest
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Nilmini Wijesuriya
If defibrillation is required, the same settings as for a non-pregnant patient should be used. The shocks from a defibrillator have been shown to have no effect on the fetus. Adhesive defibrillator pads are preferable to defibrillator paddles, and the left defibrillator pad should be placed lateral to the left breast. If fetal monitoring equipment is being used, then these should be removed from the woman before defibrillation is performed. If the uterus is manually displaced to the left or if the left lateral tilt is achieved by a person placing the knees underneath the woman’s thorax, then this should be discontinued during defibrillation.
Complications of Septal Myectomy
Published in Srilakshmi M. Adhyapak, V. Rao Parachuri, Hypertrophic Cardiomyopathy, 2020
Lawrence M. Wei, Charlotte Spear, Vinay Badhwar
A patient with an extremely thick septumor high degree of LVOT obstruction may be at elevated risk of ventricular arrhythmias and sudden cardiac death (SCD). Septal myectomy (SM) may actually reduce the risk of ventricular arrhythmia [14]. If the risk of such arrhythmia and SCD is judged to be high, an implantable cardioverter-defibrillator (ICD) should be placed. Alternatively, the patient at risk may be discharged with a wearable external defibrillator.
Recognition and management of cardiopulmonary arrest
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
There are different types of defibrillator available in clinical practice: Manual defibrillators: these require a high level of rhythm recognition skills on the part of the operator but have the advantage, when used in expert hands, of reducing the delay in compressions to less than five seconds.Automated external defibrillators (AEDs): these are sophisticated computerised devices that can reliably analyse the heart rhythm and, through voice and visual prompts, guide you through safe defibrillation. In areas where staff may not have skills in rhythm recognition and/or do not use defibrillators regularly, training in the use of AEDs is achieved much more easily and quickly than in the use of manual defibrillators, and offers a way of achieving the goal of delivering the first shock within three minutes of collapse.
Vericiguat for the treatment of heart failure: mechanism of action and pharmacological properties compared with other emerging therapeutic options
Published in Expert Opinion on Pharmacotherapy, 2021
Jean-Sébastien Hulot, Jean-Noël Trochu, Erwan Donal, Michel Galinier, Damien Logeart, Pascal De Groote, Yves Juillière
Available pharmacological therapies in HFrEF consist of renin-angiotensin-aldosterone system (RAS) blockers (either angiotensin-converting-enzyme inhibitor [ACEI] or angiotensin receptor blockers [ARB]) or angiotensin receptor-neprilysin inhibitors (ARNIs, such as sacubitril/valsartan) and mineralocorticoid receptor antagonists (MRAs), that are combined to beta-blockers and diuretics including loop diuretics [7]. When required, a cardiac resynchronization therapy ± implantable cardioverter defibrillator are used. While these therapies address the main pathophysiological mechanisms activated in HF, the WCHF population remains at risk of high event rates despite their effectiveness. Consequently, there is a clinical unmet need to provide more therapeutic options investigating new pathways for patients with WCHF.
Predictive Utility of End-Tidal Carbon Dioxide on Defibrillation Success in Out-of-Hospital Cardiac Arrest
Published in Prehospital Emergency Care, 2021
Michael W. Hubble, Lee Van Vleet, Stephen Taylor, Michael Bachman, Jefferson G. Williams, Raymond Vipperman, Ginny K. Renkiewicz
Clinically, some prior investigations have demonstrated that survival is improved by a period of chest compressions prior to defibrillation when EMS response time was greater than 4 or 5 minutes (14,15). However, two other studies found no improvement in outcomes when CPR was performed 1.5–3 minutes prior to defibrillation regardless of response time (16,17). A meta-analysis by Simpson, et al (18) pooled the results of the studies by Wik, et al (14), Baker et al (16), and Jacobs, et al (17) and found neither benefit nor harm in delaying defibrillation for a brief period of CPR. A subsequent systematic review also failed to rule out the superiority of either treatment (19). The conflicting results of these studies notwithstanding, these are all time-driven protocols that attempt to improve myocardial metabolism with a fixed duration of CPR prior to defibrillation. As such, these formulae do not represent an individualized strategy where high-quality chest compressions of unknown, and likely varying, duration may be required to restore the myocardium to a physiological state necessary for a successful defibrillation. Therefore, what is needed in the prehospital setting is a rapidly deployable, noninvasive measure of myocardial status that can predict when a defibrillation attempt would be of most benefit. Such an approach to resuscitation would be patient-centric rather than time- and protocol-centric and would thus represent a paradigm shift in the management of prehospital VF.
Coronary vasospasm as an etiology of recurrent ventricular fibrillation in the absence of coronary artery disease: a case report
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Binita Bhandari, Tejaswi Kanderi, Keerthi Yarlagadda, Mehreen Qureshi, Saketram Komanduri
Management of VF is time-sensitive as it can cause sudden cardiac death if not immediately reverted and also involves diagnostic testing to delineate the cause of VF if possible. Defibrillation remains the mainstay of treatment to prevent significant mortality during acute episodes as well as to prevent further VF episodes. The literature on VF caused by coronary vasospasm is evolving, and a range of presentations from mild chest discomfort to myocardial infarction and life-threatening arrhythmias and sudden cardiac death have been reported [13]. Our patient had recurrent hospital admissions (Figure 5) with chest pain and ST elevations noted on ECG leading to a coronary catheterization. Once ACS was ruled out, VFib was attributed to coronary vasospasm, which was further supported by recurrent episodes with potential anginal attacks but a decrease in the frequency of ICD shocks with the management of coronary vasospasm by calcium channel blockers and nitrates.