Dr. Bruce Janiak's Cardioversion from Atrial Fibrillation
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- Опубліковано 27 вер 2024
- Dr. Bruce Janiak, a 74 year old full-time emergency medicine physician, allows a video of his cardioversion from atrial fibrillation in order to demonstrate both the ease and safety of this procedure. Dr. Janiak holds the distinction of being the first ever emergency medicine residency graduate in the world.
Dr. Mellick,
I felt honored watching this case. The history behind this man. I only wish I was talented enough to write his biography and the history or emergency medicine over the last 40 + years.
I worked with a RN that retired about 8 years ago. She would tell me about the days in CCU when the patients were on bed rest for 5 days post MI, giving 20 mg of MSO4 as a single dose, and reusable needles pre HIV.
This is an awesome tribute that he allows "HIS" ER staff to care for him vs EP. Was really an awesome video. I just watched it again and am in awe of this man.
Thanks you for making my week!
Thank you for your kind words! I totally agree.
Watching this has made me feel more confident in having a cardioversion next week. I'm 76 years of age, a couple of years older than this gentleman. I will be put to sleep, which is a relief. I must confess I had thought of cancelling, I was frightened, but after seeing this brave man I think I will go through with it. I hope he is now fit and well.
Hey man, how did it go?
Love how he worked a whole shift with heart issues. Hardcore!
Dr Bruce Janiak you are an amazing person. it's inspiring that you have been serving medicine for long time and still up to date with everything.
Totally agree.
Can I please mention how beautiful it was to watch this video. It reminds me of everything that made me enter medicine. Thank you. He is brilliant.
Thank you!!
74, and he worked a whole shift with an arrhythmia and not having eaten anything. Glad he's doing better!
Pretty impressive guy!
Dr.Mellick I am addicted to your youtube channel. I have transitioned as a RN from working at a outpatient dialysis clinic to an ER located in an urban region in N.J that never has a dull day. Your videos have helped immensely. Thank you in advance
Excellent! It really helps to hear comments like yours!
Wonderful. Thank you. I'm going ahead with my cardioversion. This doctor has allayed my fears. God Bless him. I'm 76 years old and not in good health, so I was worried. Better the devil you know I kept telling myself. Now, I going to have the cardioversion done next week. Hope you are well and fit, you are such a fine trooper. Thank you to the person doing the filming. A very professional approach. Well done everyone.
That is great news.
Guess the old saying of "Doctors make the worst patients" is wrong. Great video.
Kudos to Dr. Janiak for making cardioversion less scary for practitioners and patients. Great video.
Thank you.
Salute for dr. Janiak and whole team for allowing this video to be shared to everyone around the world. Love from Indonesia.
I had my cardioversion done today and there was nothing to be frightened of. Instead of permanent AF, I now have an ectopic beat which I'm told is harmless. Thank you Dr Bruce, without your video I might well have cancelled. You are a great doctor. Thank you, too, to the Cardioversion unit at Musgrove Hospital, UK. You are all fantastic people. From start to end you were all so professional.⭐️⭐️⭐️ Beautiful Souls.
Excellent! Thank you for your comments.
were you in and out? I suffer from extreme anxiety and don't know if i would even make the appointment!
For a DR to do this on UA-cam for people to learn is amazing! Good job!
I was stuck in AFib for 2 months before they cardioversion had a fib all my life been shocked eight times already
Thank you A LOT Dr. Janiak for making this educational video - generous of you. i'm having a cardioversion next Wednesday - I have to stay in the hospital for 2 days before the procedure b/cuz they want me to take Tikosyn for the 2 days preceding the cardioversion which I think is to make sure I'm not in AFib when the cardioversion is done on the 3rd day. I am much less scared of the procedure thanks to Dr. Janiak, the technicians and the people who did the videotaping. What a TEAM!!!!!!!
Wow... he was #1? That is amazing and major kudos to him taking that step. Great video!
Thank you!
THANK YOU and THANK DR JANIAK - very helpful to see how short the period of anesthesia is when deciding on advisability of procedure in somewhat cognitively compromised 90 year old.
Thank you for this video. As an RN, I am far more comfortable with A-fib from the other side of the bed rail. Now I have it, and they scheduled my cardioversion today. Your straight-forward approach to this has calmed my anxiety a great deal. Again, thank you!
Thank you very much as usual and thanks to everyone in the video. I solidify my learning of text books by watching your videos; very entertaining.
Thank you so much for providing these videos! I can't tell you how much it helps to see real life scenarios over reading about them in a text book or listening to a lecture! Please keep it up!!
Dr. Mellick, I very much enjoy your videos and appreciate the effort you put forwards to make them!
Thank you. They are a lot of work, but definitely worth the time.
Wonderful video! So much respect for you and Dr. Janiak!
Thanks Lovena!!
This actually made me tear up. I went to the E.R. in 2016 for what I thought was the flu. Turns out I was in AFIB so they admitted me. My blood pressure was all over, the doc's kept saying stop that. I was n there for 4 days when they wheeled me to get a cardioversion. At the last minute another Dr came in and found out my Thyroid was 7X overactive. They didn't do the cardioversion. 6 months later I got the cardioversion and I felt like a million bucks! Since then I have had a thyroidectomy, and have been taking my meds. No afib, no weird internal set backs! I will admit the cardioversion was the scarest thing. And I had some burns from it. When I woke up from it my wife was crying, that worried the hell out of me. But, they were tears of joy. Long story short, if Dr's recommend a cardioversion, do it! You will feel so much better!!!!
I have a cardiac disorder test coming up. This is a great video! Incredibly informative. I shared this with my classmates.
Excellent! Thanks.
Dr. Mellick,
What a fantastic thing to witness! Kudos to the entire ER staff & this wonderful ER doctor for allowing us to be a part of this. Oh, how I miss nursing so much. I had nothing but A+ care from my many times in MCG's ER from May 1997-March 2005, I was the "Excitement" during my first stay there. Transferring via ambulance from Aiken to the ER at MCG, I was a very, very sick lady, septic, weak, around 100 lbs. by then, & scared to death about having an ERCP done, the reason for me being there. The nurses calmed me with their care & meds that should have been prescribed to me before then, but they made sure they were then! I too was the "subject" that allowed photos to be taken during the hepaticojejuemostomy that very early Saturday morning May 17, 1997. Also, I was in the largest surgical room, at that time. After placing the epidural, for pain management for the first few days post-op, I then turned & laid back on the surgical table, & above me all the way around, were med students, interns, residents, & many others there to see my surgery. That's when it kicked in for me how big of a deal my surgery was!!! Of course, I choked up & in walked Dr. David Crist, my savior. He calmed me down & asked one of the nurses to keep an eye on me & help me stay calm. Afterwards, I realized how important the surgery was & I was so honored to play one of the most game this!!!!! Thank-you again for letting me share this wonderful memory. Thank-you for being involved in the cardiovertion & sharing it. My best to the doctor-patient. Blessings!!
I love the cards I purchased a few weeks ago!! They are really great!
Excellent! Thank you so much for your comments. Glad you love the cards.
Thank you for allowing your cardioversion to be filmed. Very educational.
Nice video as usual, Doc! Blessings to Dr. Janiak!
Getting ready to schedule mine. This is a great help
I don't need to have this done (I don't meet the necessary prerequisites), but your confidence is inspiring! Thank you!
This was excellent. I have just had cardioversion in Watford General in the UK but made the mistake of watching some of the bad UA-cam clips and so I had a "discussion" with my gas man when I told him I wanted alfentanil in the "anaesthetic mix". Being the good lad he was he certainly did and I was back on the ward in 10 minutes after a pain-free burn-free return to sinus rhythm . I should have only watched this vid. I have to add that in the UK as with all procedure/surgery/intervention mine was free of any charge. Even got a chicken sandwich and some fabulous and funny nursing .
Amazing doctor ,love his confidence
Very informative. I was under cardiologist care for over 10 years for valve issues. Then developed afib and my doctor caught it. He put me in warfarin for a few days and scheduled me for a cardioversion. But they found that I'd gone Back to normal. I was admitted and out on medication. A few years later drunk driver hit me & husband. We survived but my husband has permanent flail chest one side, 4-12 ribs gone. Lost job, lost insurance and I can't afford Obamacare, don't qualify for Medicaid because my husband makes a few dollars too much on his SSDI and tiny pension. So lay in bed with my heart pounding, fluttering and feel so tired. I take aspirin and wait for the big stroke. Told my husband no life support and no medical intervention. To let me go. I can't get SSDI because I had quit working & going to college full time. They lapsed any credits before the 10 years require of work credits so I'm short on that. What will be will be.
Sorry to hear that you are down on your luck. Glad the video was helpful.
Thank you for this, please keep them coming, it’s extremely informative, especially for Med students!!
I’m about to be 59 and I had no idea I had AFib. It was found during an annual physical. This procedure was amazing. Other than a bad sore throat from the camera sent down my throat , it was painless.
My brother was in the ICU for almost a month with CHF/AFIB of 170-200 bpm. He also had severe COPD. After weeks of medication and unsuccess at lowering his heart rate they did a Cardio ablation with inserting a pacemaker. A few weeks in rehab and he went home. He has been home for over a year now with no complications.
is he on any oxygen?
This has given me confidence to go for mine later this month.
Thanks for the video
Thank you so much......please more &more teaching videos including anesthesia....sedation etc because very helpful very valuable....indications,,,absolute contraindication...be ready for the worst in reasonable time....not long.....again wonderful video
Thank you, I will
I had this done about three years ago. If you have to have it done, do not be too alarmed. From the minute I woke up. I felt great, and I have been in sinus rhythm ever since.
At 10:13, the physician had a saline flush with no cap just inside his pocket? Seems like an unnecessary infection risk, especially coming from a physician.
Dr Bruce is a LEGEND :D
Absolutely!
Excellent video! I wish more ER doctors would follow the actual appropriate algorithm's as opposed to always just giving cardizem and not actually fixing the rhythm.
great .. did one the other day but this one was an elite patient!
I have had two. I wish I had seen this video before hand! I hope it puts someone's mind at ease before hand.
Another great video. If I may voice a concern, why did the nurse have to remind the resident to get a 12 lead ecg? It appears that he was ready to go to 200 joules based on the monitor. Sorry if I sound critical. Maybe I'm missing something. Regardless, you always put out a new and interesting topic with your videos. Well done!
The nurse was right on here. The attending seemed to not think 100 joules would work. And, he briefly made the mistake of trying to rely on the monitor for this slow atrial fibrillation. My videos are real life, and in real life the nurses play a huge roll in reminding and prompting us and this is just an example of that.
Larry Mellick “Doctors save lives, nurses save doctors”
Thank you so much. I am in my last semester of nursing school and we are taking cardio.. Its one thing to read about it, but another to watch. Thank you so much.
one of a kind video...simply awesome
Thank you!!
Thank you for this video. This was very helpful education. Hope Dr. Janiak is well.
I love those who have a passion to teach
Excellent case.
Thank you Dr Janiak.
Very cool! Thank you Dr. Janiak.
I've had one episode of PSVT and got adenosine in the ambulance. That hurt like an SOB but I corrected pretty quickly. I can't imagine getting cardioversion although I didn't get any sedative. This is such a great prospective since the pt is a doctor
i had this done at 35 at 4a.m in the morning. was having a terrible A Fib episode and needed it done. it was easy. i do remember the pain of the jolt, they had to do it 2 times on me. because of the higher voltage i did have vary minor burns where the pads where and it was like a sun burn for a few days. other then that i was home and in bed by 7a.m. after some monitoring.
Nice, thanks for sharing your experience!
Your channel is really awesome sir ..
Thank you, Kiruba!
That's Doctor to you
yo! thanks doc.
great video as usual
just one thing.
propofol inhibiit / reduce ventilation, thats a fact.
Apneic oxygenation will hold high saturation just for a while.
you can see from 11:47 till the jaw thrust and beyond thet he is not ventilating or ventilating so shallow to use just the dead space
my message is , to ventilate slowli and gently with a bag mask if patient desaturate.
: )
I agree with your comments. Thanks.
I got cardioverted at 27 after being in A-fib for about 10 hrs. The head tingling before you get knocked out is freaky
Good job to the dr or nurse suggesting an EKG strip while the doc was already setting up for 200 shock.
Thanks, I've had 3 of them but never saw what went it to getting set up or what it looked like while going thru it now I know.....
amazing video. It helping me out to understand cardioversion as a nurse and the same time gave some tips to share with my patients. thanks Dr.
"The Godfather"..glad he's doing ok.
ED gave me a 6mg dose of Adenosine when my HR was over 170.
Fantastic Video !
Thank you so much for sharing !!! :)
You are welcome!
Great video, thanks for sharing.
Awesome video
34yr male. I have been cardioverted 4 times now due to intermittent afib that is trigger when playing basketball. It definitely is a scary process the first time around. Unfortunately I have become a professional at this. I have lost 30 pounds, discontinued playing basketball. I am just walking more to stay active. I miss playing basketball though. I have not had any afib episodes. My EP was considering a cardiac ablation, but my wife and I decided against it. Thanks for this video, I have always be curious about what goes on once those meds kick in.
I've been cardioverted last weekend.. and 3 years ago. I'm turning 34 next week and I've been considering the ablation as well. I might go instead with the "pill in a pocket" treatment... I'm watching this video for the exact same reason as you.. was curious to see what It looked like when med kicked in haha!! Our stories look alike Nathan.. but my afib both time started while I wasnt doing anything.
Yes our story sounds very similar. Sorry to hear your going through that same thing. Ya I have my pill in the pocket also. Although the meds have never put me back in normal rhythm, only the cardiovert. I hope everything gets better for you!
@@NathanPsprague so what kind of rythm you get when taking your pill ?!
Just the same aFib. It’s seems that the medication has little to no effect. Although when I do take the meds the cardiovert works better. The one time I didn’t take the meds and they tried a cardiovert, I was still in aFib. Everyone is different though so hopefully that approach works better for you!
Just the same aFib. It’s seems that the medication has little to no effect. Although when I do take the meds the cardiovert works better. The one time I didn’t take the meds and they tried a cardiovert, I was still in aFib. Everyone is different though so hopefully that approach works better for you!
Im only 30 years old and i have an irregular rythem got this tommorrow hope it works as i hate being on apixaban
Good luck!
It worked but still on the apixaban
i was cardioverted yesterday
Is 74. Treats patients while in atrial fib. I don't know if that's a feature or a bug, but seems to be one tough hombre.
Such an awesome Dr.
They told me when the propofol was kicking in I said "Whoa, see you on the other side."
me too!
Great video guys, thanks for sharing. I've shared it with my students in my PA Cardiology course. Thanks!
Thank you so much for your excellent video, Dr. Mellick!
One question: It appears to me that the doc at 10:13 stores is saline syringe (unprotected) in his pocket. Doesn't seem like a good place to me, does it?
God bless you all.you are all great.thank you so much👌
Why don't you preoxygenate with a non-rebreathing mask for 5 minutes before giving the propofol? The apneic time before desaturation would be significantly prolonged. That patient may not have desaturated at all
Thank you for sharing.
Thank you so much for uploading the videos really helpful
This is amazing.
Dr. Mellick,Did he ever have a heart ablation before this? BTW: My buddy was born with an extra SA Node, discovered during his heart ablation. And he had zero of the risk factors for A Fib till one day his HR hit 150+ at rest.
No ablation.
most of the cardioversion cases I've seen or learn about from my patients their a fib will eventually come back :(
ablations seems to lasts longer and has a higher chance of holding regular sinus although I've heard of patients getting 2 or 3 ablations to fix their a fib
Really interesting
He hasn't eaten all day, any chance his electrolytes are a little wacky? (I'm a cardiomyopathy patient. I absolutely love these videos!)
Not that quickly, but thanks for the nice comments.
he is so cool God bless.
He is a Superman! My new Hero!
Thanks for this video ! Infact thanks for posting all the amazing vids on this channel . Really helpfu to watch just before osces :)
Very good video. Thank you.
Thank you.
This has been extremely informative. Thank you for publishing this video!
Well now...Got that chapter out of the way....
70mg propofol for sedation on cardiovascular 72y is kinda heroic. gotta love the little apnea there "just a lil side effect" lol
bluti lmao right ?
loved that video....very useful for me...thank u
Hi Dr. Mellick, loved this video, among many others. I'm a Paramedic, and while I don't think we'll be getting Propofol to use at our own discretion (other than IFT work) any time soon, what would you think of using Ketamine, maybe 1-2mg/kg for this sedation in this case? At the moment, Versed 2-5mg is the prehospital standard, and it's never seemed like enough to me. With the low risk of airway compromise/hypoxia, Ketamine seems ideal. I've heard tell and very occasionally seen emergence phenomenon in adults, but I can always mitigate that with a small dose of Versed, and I always pretreat with Zofran. I'd love to hear your thoughts, or those of your colleagues on this. Thanks again, and thanks for all the Med Ed!
Thank you very much. Some videos are more fun than others and this was one of those. In my opinion, ketamine is a drug one can use in the prehospital setting. At lower doses it is even safer (and with less side effects) and the biggest risk comes from pushing the drug too fast.
Notice that the vectors of right and left atrial depolarization appear to have separated.
WPW Atrial fib or flutter cardioversion is the safest treatment. I'm not saying he has WPW
I've had two. I didn't feel anything and came right out of afib. Shortly after I woke up they sent me home.
Love this guy!
I've had to be cardioverted chemically 3 times and had 2 ablation that didn't work unfortunately.
Ouch! Sorry to hear that.
How are you now? I've had 6 cardioversions and a 7th done chemically. I have a cleft in my mitral valve which they are going to repair and put a ring in the valve so it will close properly. As well as do a MAZE procedure( an open heart ablation) having this done in 11 days. Yikes!
Boy, that would be really embarrassing to convert him to asystole on UA-cam...Outstanding video!
TheMicroTrak seriously? i didnt not see aystole!.. when did you see that? hope you don't mean before the ekg eletrodes were reconnected to get the rythm post cardioversion. watch the video again.
Thankfully that didn't happen. It's pretty rare to have rhythm problems after cardioversion.
TheMicroTrak Roger those keywords!
Freda, sorry about the delayed response, nope, I never saw asystole. I have seen many well meaning paramedics try to convert asymptomatic AFIB in the field, and make it worse. If the heart is still ticking, I say let the ER shock'em. It would be embarrassing to toast a demi-god of emergency medicine, and I am glad the patient tolerated it well.
The only down side is after you wake up you feel so drunk like I drank like 7 beers in a row, and I usually dont drink not even a beer.
Why wasnt he ventilated? I got a tube in my mouth every time I got general anestesia.
Propofol is great for a quick KO but when you wake up you are more asleep/drunk than awake for like a day.
I would think that side-effects and intubation would depend on the person, length of procedure, and the doctor. When I had propofol I didn't have intubation, nor the "asleep/drunk" for more than 10-minutes after waking up. At 4:45 the doctor stated he likes to only give half the dosage as recommended based on weight, and then use the rest if needed. At 12:34, you can hear how Dr. Janiak had minimal drop in oxygen saturation, and didn't need a mask or tubing but sometimes others do.
propofol is moderate sedation, not general anesthesia. Big difference
not me i had ( the michael jackson drug) many time no side effects, i love it !!!
I really appreciate this video. But in a way it was so weird. Lol. I always wondered what happened when Dr. go to the Dr.
I had heart attack when I was 22 , then started having a fib ,,in 1983,,,, a flutter and SVT, I developed agoraphobia i have taken heart meds since 1983 Inderal Beta Blockers Lanoxin,,calicum channel blockers ACE inhibitors,,,I have taken over half million Heart pills ,,I was in a fib for nine months in 1994,,,and converted on small dose of lanoxin ,,, I am now 62 ,,I dont know if my life has been worth living ,,,a fib took my life away ,,I take Timolol and Valium 5 and asprine ,,,,I forgot to take my Timolol yesterday and went in to A Fib 160 heart rate and 170.120 blood pressure ,,, my mind almost shuts down like a the Living dead ,, Here is south east Kentucky the Doctors are fools ,,,I hope my heart converts to sinus I am getting to the point I dont want to Live any longer ,,,,I cant stand this any more after forty years of tourment ,,,,I wish I had never been borne .
Anything has a reason and find meaning to your life while you are breathing. I will pray from you.
It's too late, but almost all of the medicines you're taking are fluoride. This causes magnesium and fluoride to combine, resulting in magnesium deficiency. This will make your heart worse. Naturally, atrial fibrillation will also worsen. Magnesium deficiency can also cause blood clots. Ironically, the more you continue to take the medication, the worse your heart disease becomes.
I have no words to say, but please live.
Hey question! How much propofol can you give until the airway is compromised?
It depends on the patient and how you administer it. Most of us calculate our total dose and give it slowly in aliquots. Here is something I found on line that describes how it acts in doses used by anesthesia.
Induction of anesthesia with Propofol injectable emulsion is frequently associated with apnea in both adults and pediatric patients. In adult patients who received Propofol injectable emulsion (2 to 2.5 mg/kg), apnea lasted less than 30 seconds in 7% of patients, 30 to 60 seconds in 24% of patients, and more than 60 seconds in 12% of patients. In pediatric patients from birth through 16 years of age assessable for apnea who received bolus doses of Propofol injectable emulsion (1 to 3.6 mg/kg), apnea lasted less than 30 seconds in 12% of patients, 30 to 60 seconds in 10% of patients, and more than 60 seconds in 5% of patients.
Larry Mellick thank you!! Great content!