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 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 😴
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!
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.
me, it was dehydration after a long period of sleep coupled with prescribed Flexaril after a heart attack and bypass 2 years earlier.@@solslastcannula5665
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.
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.
My dad had this done a few days ago in England his heart was beating at 145 Bpm they shocked him once he died for 2 minutes they then brought him back round and now he is perfectly fine feeling fresher then ever and down to 80bpm
it can be symptomless. I felt only a fish flopping sensation but otherwise fine. Another time there were 4-6 second pauses of my heart and they felt TERRIBLE. I closed my eyes and tried to relax. Your head feels a lightheadedness like you are going to die, then it spread further each time until it went all down my body and down my extremities, sort of an electric vibration feel to it. hard to describe. My chest was tight and it was hard to breathe.
@@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!
at first it was, a bit, but then I felt peaceful. When it was just my brain it was terrifying and I knew immediately to call 911. Later it spread down my torso then out to my limbs, not up. Interesting yours was the opposite. My heart was pausing for 4-6 seconds at a time as the fast heart rate (160 plus) tried to convert to a slower more normal rhythm. @@DiosaDe1So1
@@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.
That is ridiculous. My husband had that done and they gave him a bit of propopol. They say his blood pressure was low but they could have given him something.
@@marvenananayo7557 Ooh. Someone is a little full of herself/himself. There are medications to help with hypotension, are there not? Even an ER nurse should know that. As well as maybe using just a very low dose of sedation. I still think what they did was a little barbaric.
@emb74 you are the one full of themselves if you dont think these doctors are trying everything. Unless you are a medical professional then you should keep your thoughts out of the comments section
@@MichaelAW17 I have been a patient on the receiving end of a lot of pain when the “medical professionals” just don’t seem to want to bother with pain relief during a procedure. All I’m saying is that it just looks needlessly cruel to me. Nothing anyone says can change the way it looks to me. I’m not saying that before the video started maybe they did try to think of everything they could do, but as I said, I have personal experience that they don’t always give a darn if you’re in pain.
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'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!
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 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..
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!
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
+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!
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 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 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.
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 ~
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.
Is it always necessary to call anestesiologist to give propofol, or you could give for example 2mg morfium or 0,5ml fentanyl before synchrone DC schock? And if TA is about 90/60, patient does not lose concious would you prefer prefer farmacological treatment or DC?
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! 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 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!!!
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!
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.
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.
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".
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.
