Repost: 63 minutes of ventricular fibrillation, followed by shock. What is going on?

In this study, 5% of VF arrest was due to PE: V fib is initial rhythm in PE in 3 of 60 cases. On the other hand, if the presenting rhythm is PEA, then pulmonary embolism is likely.  When there is VF in PE, it is not the initial rhythm, but occurs after prolonged PEA renders the myocardium ischemic.--Another study by Courtney and Kline found that, of cases of arrest that had autopsy and found that a presenting rhythm of VF/VT had an odds ratio of 0.02 for massive pulmonary embolism as the etiology, vs 41.9 for PEA.    ===================================MY Comment by KEN GRAUER, MD (6/27/2020):===================================As I reviewed the above series of 4 tracings in active search for insightful commentary about the various cardiac rhythms — I found myself continually returning to Dr. Smith ’s 3rd Learning Point cited above = “ECGs may be very bizarre immediately after defibrillation. Give it a few minutes to record another before drawing conclusions.” As motivated as I was to devise some new, definitive interpretation for the rhythms in this case — it didn’t happen for me. Instead — I’ll simply add this 9th Learning Point:Accept that your peri-resuscitation patient may not show you an easy-to-interpret tracing. When this happens — Be content with the basics. VFib and malignant VT rhythms need to be shocked. In co...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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