Some	DT
patients	NNS
converted	VBN
from	IN
ventricular	JJ
fibrillation	NN
to	TO
organized	JJ
rhythms	NNS
by	IN
defibrillation-trained	JJ
ambulance	NN
technicians	NNS
will	MD
refibrillate	VB
before	IN
hospital	NN
arrival	NN
.	.
The	DT
authors	NNS
analyzed	VBD
271	CD
cases	NNS
of	IN
ventricular	JJ
fibrillation	NN
managed	VBN
by	IN
EMT-Ds	NN
working	VBG
without	IN
paramedic	NN
back-up	NN
.	.
Of	IN
111	CD
patients	NNS
initially	RB
converted	VBN
to	TO
organized	JJ
rhythms	NNS
,	,
19	CD
refibrillated	JJ
,	,
11	CD
of	IN
whom	WP
were	VBD
reconverted	VBN
to	TO
perfusing	JJ
rhythms	NNS
,	,
including	VBG
nine	CD
of	IN
11	CD
who	WP
had	VBD
spontaneous	JJ
pulses	NNS
prior	JJ
to	TO
refibrillation	NN
.	.
Among	IN
patients	NNS
initially	RB
converted	VBN
to	TO
organized	JJ
rhythms	NNS
,	,
hospital	NN
admission	NN
rates	NNS
were	VBD
lower	JJR
for	IN
patients	NNS
who	WP
refibrillated	VBD
than	IN
for	IN
patients	NNS
who	WP
did	VBD
not	RB
,	,
although	IN
discharge	NN
rates	NNS
were	VBD
virtually	RB
identical	JJ
.	.
Scene-to-hospital	JJ
transport	NN
times	NNS
were	VBD
not	RB
predictively	RB
associated	VBN
with	IN
either	RB
the	DT
frequency	NN
of	IN
refibrillation	NN
or	CC
patient	JJ
outcome	NN
.	.
Defibrillation-trained	NN
EMTs	NN
can	MD
effectively	RB
manage	VB
refibrillation	NN
with	IN
additional	JJ
shocks	NNS
and	CC
are	VBP
not	RB
at	IN
a	DT
significant	JJ
disadvantage	NN
when	WRB
paramedic	NN
back-up	NN
is	VBZ
not	RB
available	JJ
.	.
There	EX
is	VBZ
controversy	NN
regarding	VBG
the	DT
appropriate	JJ
utilization	NN
of	IN
health	NN
care	NN
resources	NNS
in	IN
the	DT
management	NN
of	IN
tricyclic	JJ
antidepressant	JJ
overdosage	NN
.	.
Antidepressant	JJ
overdose	NN
patients	NNS
presenting	VBG
to	TO
the	DT
emergency	NN
department	NN
are	VBP
routinely	RB
admitted	VBN
to	TO
intensive	JJ
care	NN
units	NNS
,	,
but	CC
only	RB
a	DT
small	JJ
proportion	NN
develop	VBP
cardiac	JJ
arrhythmias	NNS
or	CC
other	JJ
complications	NNS
requiring	VBG
such	PDT
an	DT
environment	NN
.	.
The	DT
authors	NNS
reviewed	VBD
the	DT
findings	NNS
in	IN
165	CD
patients	NNS
presenting	VBG
to	TO
an	DT
ED	NN
with	IN
antidepressant	JJ
overdose	NN
.	.
They	PRP
found	VBD
that	IN
major	JJ
manifestations	NNS
of	IN
toxicity	NN
on	IN
ED	NN
evaluation	NN
were	VBD
commonly	RB
associated	VBN
with	IN
a	DT
complicated	JJ
hospital	NN
course	NN
.	.
Patients	NNS
with	IN
the	DT
isolated	JJ
findings	NNS
of	IN
sinus	NN
tachycardia	NN
or	CC
QTc	NN
prolongation	NN
had	VBD
no	DT
complications	NNS
.	.
No	DT
patient	NN
experienced	VBD
a	DT
serious	JJ
toxic	JJ
event	NN
without	IN
major	JJ
evidence	NN
of	IN
toxicity	NN
on	IN
ED	NN
evaluation	NN
and	CC
continued	JJ
evidence	NN
of	IN
toxicity	NN
during	IN
the	DT
hospital	NN
course	NN
.	.
These	DT
data	NNS
support	VBP
the	DT
concept	NN
that	IN
proper	JJ
ED	NN
evaluation	NN
can	MD
identify	VB
a	DT
large	JJ
body	NN
of	IN
patients	NNS
with	IN
trivial	JJ
ingestions	NNS
who	WP
may	MD
not	RB
require	VB
hospital	NN
observation	NN
.	.