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

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

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.

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

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

Thank goodness for modern medicine and these excellent doctors.

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

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!

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

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.

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

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. ❤

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

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.

Dr: - That EKG is horrible even after!! Heart Failure or Severe Infection?

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

I was shaking watching this , ,hope he is ok

how terrifying but how impressive.

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

They put me under with Ketamine when they did this to me last year. It was a very pleasant experiance as weird as that sounds

We do it in Germany after having administered a painkiller and a hypnotic😊.

How hes still awake when his hr is that high is beyond me

What BP is needed for decent sedation?

255?! How the hell is this man even awake?

The only thing that stopped my Afib was the pacemaker. Medicines did not help.

My cardioversion results lasted thirty minutes!

No sedation???

Took that shit like a champ 😅

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.

Really no sedation..!!!

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

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.

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

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!

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

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..

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!

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

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

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

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.

Thank you! They are a great team.

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

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!

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

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.

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.

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

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

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

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

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

Thanks drs and patient

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".

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

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

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

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 :)

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

Thank you from a nursing student.

The nurses are amazing

Thanks!!

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

Thanks!

Thanks!

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

I hope he had a speedy recovery

at 0:46 he says "6, then 12 of adenosine. We did 24 along with vagal maneuvers". 24 of Adenoside or b-blocker..?

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.

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.

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 ~

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

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.

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!

Thanks for the video!

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 am addicted to your videos. So interesting and informative

I love your educational videos.

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.

thanks for teaching us))

Thank you so much! Appreciate.

Although propofol was contraindicated due to his low BP, would there have been any reason why etomidate wouldn't have been viable in this situation?

Brave man,heroic staff.

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

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!!!

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

You are welcome.

thank you, very educational

Thank you

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.

That's an amazing procedure

Got both. The last event was cardioversion.

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.

thanks dr.

awesome videos! Thank You Doc! :D

why the pt seems alert when HR @256, but confused when HR drop to 120?

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