NR practical Monophasic vs Biphasic

[donedeal]

Does anyone know whether National Registry centers its practicals and exam questions around a monophasic or biphasic defibrillator?

[Kaisu]

Depends on the center. It can be either, but I think most have biphasic machines. Learn the dosages for both.

[AZCEP]

There is no difference from a guideline perspective on the "dose"

The current reccomendation is "maximum allowable by the manufacturer". Maximum setting for all unsynchronized shocks.

[Kaisu]

Doses vary depending on if you are doing pacing, or if it's the first or subsequent shocks in both synchronized and unsynchronized cardioversion. Pediatric dosages are weight dependent and vary depending on if it's the first or subsequent shocks. Where you start is different on biphasic vs. monophasic machines.

[AZCEP]

Biphasic/monophasic does not apply during TCP. Pediatric energy levels have not changed, and does not differ between mono-/biphasic equipment.

The initial energy setting does not change for adult or pediatric. Peds are still treated with 2 joules/kg for the first shock, and 4 joules/kg for subsequent. Adults are managed with the maximum device allowable throughout.

[Kaisu]

Ok... so this is what I was taught - is it local protocol?

Synchronized Cardioversion

- Biphasic

o 70J-100J 1st round

o 150J 2nd round and all rounds thereafter

- Monophasic

o 200J 1st round

o 300J 2nd round

o 360J 3rd round and all rounds thereafter

Trans Cutaneous Pacing

no difference in Mono or Bi phasic.. ( start at rate of 80 and 50 mA, increasing mA until electrical capture)

Defibrillation - manufacturer recommended maximum dosage..

So thanks for making me re-clarify that to myself.

[chbare]

Ok... so this is what I was taught - is it local protocol?

Synchronized Cardioversion

- Biphasic

o 70J-100J 1st round

o 150J 2nd round and all rounds thereafter

- Monophasic

o 200J 1st round

o 300J 2nd round

o 360J 3rd round and all rounds thereafter

Trans Cutaneous Pacing

no difference in Mono or Bi phasic.. ( start at rate of 80 and 50 mA, increasing mA until electrical capture)

Defibrillation - manufacturer recommended maximum dosage..

So thanks for making me re-clarify that to myself.

Are you sure the above cardioversion guidelines are correct? For example, the monophasic guidelines you stated are in fact what ACLS at one time advocated for monophasic stacked defibrillation shocks. In addition, starting cardioversion at 200 joules monophasic is a bit high especially if you have a stable SVT or new onset A-Flutter.

Take care,

chbare.

[chad]

I had the same type of Issue's going through my NREMT-P practicals. No one seemed to know whether we were suppose to use mono 360 or biphasic 200. Then like 2 days before we tested we were notified that the National registry doesn't care if you use mono or bi, they just want to see if your using the proper shock sequence for the type of defib/monitor you have. I know when i went through, i went straight off my ambulance service's protocols which in my case was a biphasic defib, i went 200,200,200. Never had no problem.

Chad,

NREMT-P

[firedoc5]

Biphasic/monophasic does not apply during TCP. Pediatric energy levels have not changed, and does not differ between mono-/biphasic equipment.

The initial energy setting does not change for adult or pediatric. Peds are still treated with 2 joules/kg for the first shock, and 4 joules/kg for subsequent. Adults are managed with the maximum device allowable throughout.

I believe we went to the same school on this, and a lot of other things apparently throughout the City. :occasion5:

[TDP]

arent the majority of monophasic defibs being replaced now?