Some_DD patient_NN2 convert_VVN from_II ventricular_JJ fibrillation_NN1 to_II organized_JJ rhythm_NN2 by_II defibrillation-trained_JJ ambulance_NN1 technician_NN2 will_VM refibrillate_VV0 before_II hospital_NN1 arrival_NN1 The_AT author_NN2 analyze_VVN 271_MC-MC case_NN2 of_IO ventricular_JJ fibrillation_NN1 manage_VVD by_II EMT-Ds_NP1 work_VVG without_IW paramedic_JJ back-up_NN1 Of_IO 111_MC-MC patient_NN2 initially_RR convert_VVN to_II organized_JJ rhythm_NN2 ,_, 19_MC-MC refibrillate_VVD ,_, 11_MC-MC of_IO whom_PNQO be_VBDR reconvert_VVN to_II perfuse_VVG rhythm_NN2 ,_, including_II nine_MC of_IO 11_MC-MC who_PNQS have_VHD spontaneous_JJ pulse_NN2 prior_RR to_II refibrillation_NN1 Among_II patient_NN2 initially_RR convert_VVN to_II organized_JJ rhythm_NN2 ,_, hospital_NN1 admission_NN1 rate_NN2 be_VBDR lower_JJR for_IF patient_NN2 who_PNQS refibrillate_VVD than_RR for_IF patient_NN2 who_PNQS do_VDD not_XX ,_, although_CS discharge_NN1 rate_NN2 be_VBDR virtually_RR identical_JJ Scene-to-hospital_JB transport_NN1 time_NNT2 be_VBDR not_XX predictively_RR associate_VVN with_IW either_RR the_AT frequency_NN1 of_IO refibrillation_NN1 or_CC patient_JJ outcome_NN1 Defibrillation-trained_NP1 EMTs_NP1 can_VM effectively_RR manage_VV0 refibrillation_NN1 with_IW additional_JJ shock_NN2 and_CC be_VBR not_XX at_II a_AT1 significant_JJ disadvantage_NN1 when_CS paramedic_JJ back-up_NN1 be_VBZ not_XX available_JJ There_EX be_VBZ controversy_NN1 regarding_II the_AT appropriate_JJ utilization_NN1 of_IO health_NN1 care_NN1 resource_NN2 in_II the_AT management_NN1 of_IO tricyclic_JJ antidepressant_JJ overdosage_NN1 Antidepressant_JJ overdose_NN1 patient_NN2 present_VVG to_II the_AT emergency_JJ department_NN1 be_VBR routinely_RR admit_VVN to_II intensive_JJ care_NN1 unit_NN2 ,_, but_CCB only_RR a_AT1 small_JJ proportion_NN1 develop_VV0 cardiac_JJ arrhythmia_NN2 or_CC other_JJ complication_NN2 require_VVG such_DA an_AT1 environment_NN1 The_AT author_NN2 review_VVN the_AT finding_NN2 in_II 165_MC-MC patient_NN2 present_VVG to_II an_AT1 ED_NP1 with_IW antidepressant_JJ overdose_NN1 They_PPHS2 find_VVD that_CST major_JJ manifestation_NN2 of_IO toxicity_NN1 on_II ED_NP1 evaluation_NN1 be_VBDR commonly_RR associate_VVN with_IW a_AT1 complicated_JJ hospital_NN1 course_NN1 patient_NN2 with_IW the_AT isolated_JJ finding_NN2 of_IO sinus_NN2 tachycardia_NN2 or_CC QTc_NP1 prolongation_NN1 have_VHD no_AT complication_NN2 No_AT patient_NN1 experience_VVD a_AT1 serious_JJ toxic_JJ event_NN1 without_IW major_JJ evidence_NN1 of_IO toxicity_NN1 on_II ED_NP1 evaluation_NN1 and_CC continued_JJ evidence_NN1 of_IO toxicity_NN1 during_II the_AT hospital_NN1 course_NN1 These_DD2 datum_NN support_VV0 the_AT concept_NN1 that_CST proper_JJ ED_NP1 evaluation_NN1 can_VM identify_VV0 a_AT1 large_JJ body_NN1 of_IO patient_NN2 with_IW trivial_JJ ingestion_NN2 who_PNQS may_VM not_XX require_VV0 hospital_NN1 observation_NN1