Emergency Cardioversion

[@maltimoto]

Patient laying there with heart rate 255 and looking very healthy.... crazy! Good to see he is ok now

[@doesgodstillspeakstoday3610]

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.

[@MrCerebellum2]

When your heart rate exceeds the BPM of the techno music it’s time for cardioversion, brah.

[@jamiefarmer3550]

😂😂😂😂😂

[@yungstitch1153]

as someone who minors in music studies, this made me laugh

[@savannahoneil-pindar4207]

Underrated comment.

[@alangeiger5237]

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

[@Mayah_Abelman]

At least the nurse was completely honest with him telling him it’s gonna hurt like hell for a second

[@jessicaesparza6287]

As a nursing student watching videos like this is really helpful! Thank you!

[@lmellick]

Cool! I am glad they are helpful!

[@MagdaCTV]

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!

[@chrisreed3435]

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.

[@lmellick]

+Chris Reed Thanks! Challenging case!

[@Barkingspider]

Nice work

[@mohammadshahade8753]

You did the cardioversion before monitoring on an EKG?

[@marvenananayo7557]

@@mohammadshahade8753 what are you talking about 🤣

[@SeanPGribbons]

Thank goodness for modern medicine and these excellent doctors.

[@czarrevs3616]

Dang! No sedation! He took it like a Champ!!

[@Aernoth1]

They gave him Versed, he already doesn't remember it.

[@HOODSSWEETIE]

He really did, I was sedated for that procedure.

[@robertthomas7094]

Ty to this gentleman for allowing me to view this so that I can learn to help.

[@lmellick]

I agree.

[@RkivUnderground]

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!

[@buddyrebel_Garcia]

His heart was about to burst, but damn that blood pressure is super low

[@windowpain1]

94/69 isn't even usually considered hypotension, though

[@lmellick]

Thank you! They are a great team.

[@lissakaye610]

Big thank you to the gentleman letting us see this procedure. Very interesting and educational!

[@lmellick]

Good! Glad it was helpful.

[@b1onik344]

256 bpm!!!! hooooly shiiiit!!! ferrari-heart

[@simbagillespie1887]

B1oniK should be dead by now

[@mrstealurkill2002]

Yep that's a Bugatti for a heart ❤️

[@pamdfromtennessee5075]

I had 290 before my cardioversion. I was praying the whole time.

[@drewie_Butts]

Pamela Dalton what the hell does that feel like? Must feel like it’s going to jump out of your chest.

[@minxiemoo69]

I had a heartbeat of 250+ bpm last week. It HURTS! lol

[@gsdgurl2010]

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..

[@lissakaye610]

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. ❤

[@PEACEinYESHUA-oj7vc1pk7w]

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 😴

[@chrisquinn4020]

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!

[@gpb422]

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.

[@lmellick]

Procedural sedation is generally safe, but these medications can lead to apnea. The oxygen is precautionary as is the end tidal CO2 monitor.

[@arose6644]

Phenomenal. I love the pt's response when asked about filming the procedure.

[@lisawoods1489]

Very helpful to watch these viseos being a nursing student with a cardiac med surg exam next week! Thanks for posting!

[@lmellick]

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".

[@jon5022]

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!

[@lmellick]

Excellent!

[@lusjokastro]

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.

[@ethanjones1836]

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

[@Barkingspider]

Don’t be so causal with it. There are risks and as you can see you return back to afib.

[@ethanjones1836]

Barking Spider dude I ain’t a doctor. I just shadow er docs all the time and it’s fun watching the procedure. Chill

[@Barkingspider]

Ethan Jones I wasn’t talking to you. Learn youtube.

[@Ladderthief1]

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.

[@javachip9612]

I've never seen such a brave old man for this he's a superhero

[@freewaybaby]

+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!

[@javachip9612]

Marcy RP ohh yeah I forgot about those! I thought we was dong it to be brqve

[@freewaybaby]

Welll..... I guess you COULD say "no", but that would be a lot braver (or dumber) to NOT do it, huh? LOL

[@javachip9612]

+Marcy RP I would rather not do it

[@freewaybaby]

Haha....yeah, I'll bet HE wouldn't have either!

[@abpob6052]

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.

[@JimmySpeeds]

i've had 12 cardioversions in 18 months, its awful.

[@solslastcannula5665]

Did you have a lot of caffeinated drinks?

[@Shaneg-tu7gt]

But you are alive to us,so it's "good".❤

[@ashleyblanchard4159]

The doctors and nurses were so great. This is the type of care i would want if i were in this situation.

[@cookmautube]

Very impressed with your staff. He was obviously a difficult patient on many levels.

[@whitesapphire5865]

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.

[@lmellick]

Thanks for sharing.

[@lmellick]

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.

[@muhammadramadhanalmushalli8222]

Larry Mellick nice. Thanks for the educational exprience

[@stevelawson36]

That's wild! I wasn't that bad when I had a Cardioversion done two years ago. Glad to see that he is alright!

[@lmellick]

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.

[@brittanygrobichaud]

I understand. Must be a hard to watch people go through pain everyday. I dont know how you do it personally! You guys are angels in scrubs :)

[@stevendeakins7569]

I used to do these with cardiologists. Miss doing these and TEEs.

[@lmellick]

Excellent!! Couldn't agree more. Thanks for the feedback.

[@lmellick]

We did too. Unfortunately with his low blood pressure the team felt uncomfortable giving him stronger sedation medications.

[@i_kissed_a_pixie1537]

I made 260 once. I feel this guy's pain

[@bbag5358]

thats terrifying... highest ive had was 176 :/ and i thought that was bad

[@scratchpad7954]

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.

[@richardsmith4881]

254 here

[@Smubbs]

Wow I thought I was dying with a 140 heart rate. This makes me feel better

[@numberone5680]

Sophie Harrington Happened w me 3x!

[@alisongasaway609]

Thanks for the video! Take my NCLEX-RN tomorrow and this was a great video for me to see how cardioversion works

[@lmellick]

Alison Wisehart You are welcome, Alison. Good luck!

[@lmellick]

Only Versed. Limited sedation medications decided by operator because of concern over recent low blood pressure.

[@-OokySpooky-]

255BPM SOLID WITHOUT A CARE WHAT A TANK!!

[@reaper.XOz.]

I hope he had a speedy recovery

[@jbmbanter]

Thanks Dr. M. If I ever end up in the GRU Hospital I will ask for you by name!

[@hellomeme94]

Thank you Larry!! I was searching for a reallife emergency videos thanks a million !!

[@lmellick]

+me mo You are welcome. I hope you enjoy my channel.

[@hellomeme94]

+Larry Mellick i did enjoy it !! great job :)

[@nellyhoffman6194]

thanks doctor ! i am a 3rd year medical student i appreciate your videos

[@lmellick]

+Lighto Yagami Glad they are helpful!!

[@lmellick]

No that would not be normal. However, I don't think it was immediately obvious to us in the room.

[@raaedravo]

I can't stop watching your videos, they are so freaking informative :)

[@roblou62]

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.

[@dianegherman9785]

Me too! I've had 2 shocks this year....there is stuff in my emotions i need help with.

[@lmellick]

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.

[@tiffanygooodin3360]

The nurses are amazing

[@faeamrhein9047]

Thank you from a nursing student.

[@jbmbanter]

Also glad to see that someone other than me, Jake Adams, knows that Oxygen does not burn. It simply supports combustion at a higher rate than the normal air we breathe.

[@lmellick]

Got both. The last event was cardioversion.

[@gagedesoto5131]

Saw this done when I was 14 as an explorer on an ambulance. No sedation at all. It was pretty cool

[@vegasjill21]

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 ~

[@lmellick]

It looks like the chest pads for the cardioversion, the monitor leads and the EKG 12 lead.

[@lovelynurse2000]

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!!!

[@cammyfayes]

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.

[@lmellick]

No that wasn't tried.

[@novu16]

great videos really appreciate,,,i have going to emergency department tomorrow for rotation and its great help...love you guys

[@amjed123456325632561]

Wow I have just found this channel it is amazing thank you

[@A.Gmd8411]

My dad just had this done yesterday morning 12hrs after his Heart Cath procedure. His heart was at 203bpm & BP was 70/40. They could only give 1mg of versed due to his low bp. He said it felt like he got kicked in the chest, seen flashing of a white light & swore he had burn marks on his chest. Thankfully he is back in normal sinus rhythm but now has to wear a life vest for 3 months in case of another episode.

[@razamadaz3417]

Brave man,heroic staff.

[@lmellick]

That would be highly unlikely, but it is a scary thought.

[@kimyuna9384]

12 years ago?!! Is he still alive?! I hope so he is amazing person may he soul be in peace

[@tanussc]

Yes you can, you just have to place one paddle 3 inches away from the pacemaker battery and the other a little lower on the ribs than you would usually do. By all means don´t put the paddle ON TOP of the battery. You could short circuit it and the patient would need to get a new one. But I tend to think they prefer to be alive and need a pacemaker change than dead with a perfectly working device.

[@mikeplaysit]

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.

[@Ronettaaa]

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.

[@CriticalCareDO]

He was already hypotensive. He received some Versed to at least relax him just enough.

[@diplomat2623]

They gave him a small dose of sedation but not too much bc of the low blood pressure.

[@macchirpy]

could have given him ketamine. we use that here in the south of England on our critical care trucks

[@loveblowupdollorgies8437]

i think ketamine alters you K+ maybe a chem8 on iv start

[@neburnynhs9394]

Snap Quartimon ketamine would raise his HR which was already high

[@lmellick]

Thanks!

[@lmellick]

Thanks!

[@inaamulhassanjaffer8238]

Thanks drs and patient

[@brittneyadams3943]

I have afib. In july i had an episode of a heart rate of 282. I was out of breath when i talked. I was in the hospital for about 12 hours until my heart beat leveled. It was a priesthood blessing that got my heart back to normal..

[@lmellick]

Thanks! Okay, I'll see what trauma video I can come up.

[@lmellick]

Thanks!!

[@m2inla]

Paramedic here. Wasn't the AHA recommended starting dose for synchronized cardioversion 50J in 2012? I'm not criticizing the treatment, just respectfully here to learn. Thanks for all of your videos, Dr. Mellick! I recommend them to my paramedic students.

[@jarnigan1]

m2inla I'm a Paramedic also. I agree. Also aren't you supposed to turn the O2 off during cardioversion?

[@GinaGabriell-e7t]

Just had this done today, I got sedation but was still aware. It worked. Technology is amazing.

[@ashleyjuvancic9086]

I am addicted to your videos. So interesting and informative

[@lmellick]

Ashley Juvancic Cool!! Thanks!!

[@varwin4308]

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.

[@lmellick]

Propofol causes hypotension and would make a low BP seriously worse.

[@medomemo1988]

thanks for teaching us))

[@lmellick]

You're welcome!

[@vitaliytseluevskiy7419]

Larry Mellick

[@valeo6820]

No mention by any staff member of giving the patient any pain medication.

[@SPARTANITE117]

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!

[@lmellick]

+Randal Perryman Thanks!

[@dominiguya5716]

Good video, but the individual pressing the shock button NEEDS to make sure everyone is clear before multiple patients develop.

[@macmedic892]

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.

[@vegasjill21]

Thanks for the info! I am new to tYT,didn;t understand in what capacity he was in these hospital, hospitals. I went to his channel but I am not very good at this YT stuff. At least now I understand why he is allowed to film all these incidents. and be able to help other people. I found his video when I was looking at a poor fellow with dry socket after tooth extraction. And I have been here for about 5 hours now!!! lol STILL looking for info on those injections he does for headache/facial pain!

[@tmichellemd111]

It means he's probably in DT's, or about to experience them, or so I'm assuming they meant by stopping alcohol (EtOH). Plus I believe I heard them order Ativan and a banana bag - another indication that they're trying to control or prevent symptoms of alcohol withdrawal...

[@lmellick]

Not VT, probably just the view.

[@MikeGoesBadaBoom]

how terrifying but how impressive.

[@lmellick]

You are welcome.

[@Firemedic284]

NICE! wide complex v- tach cardioversion! what really sucks is when they dont convert and begin to lose consiousness then the real fun begins!

[@sincerelyadelina4811]

I had 183 bpm Tuesday and have SVT and palpitations. I can't imagine 256!

[@MariaRiveriaHernandez]

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.

[@habib080]

I love your educational videos.

[@emmettoransky5088]

My veins felt painfully constricting and oxygen affected at 165. How is the pt so chill??? Let alone at 236!!

[@zeynepaleynasimsek8189]

After some point you don't even feel your heart beating. Just a little uncomfortable.

[@DiosaDe1So1]

@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!

[@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.

[@maridelmar22]

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

[@thedeviouspanda]

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.

[@gregorycarroll5298]

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.

[@brig.4398]

Next time I want this treatment, instead of waiting for hours on end while my heart goes bonkers.

[@tomkhankin6540]

the music at the beginning is kind of representing his heart lol

[@chanjunior100]

no sedation because blood preassure low. . u see monitor show b/p 88/67 and 82/63