New ACLS Save!

[vs-eh?]

New guidelines are 360J monophasic (200J biphasic) on all shock deliveries. AEDs are being reprogramed.

The monophasic joule setting is alway 360J and single shocks (no stacked) in a cardiac arrest.

Biphasic still does escalate (not just 200J), 120-150-200J in single shocks (no stacked) assuming you need more than one.

Monophasic arrest? 1st shock? 360J 2nd? 360J 10th? 360J...

Biphasic arrest? 1st shock? 120J second shock? 150J 10th? 200J...

[Thunderchild145]

I would have to agree that bagging while doing compressions would not be effective and would at best cause alot of Gastric Distention. So that is kind of odd to me. A couple other things in this scene don't make sense to me, maybe someone can help me understand or you could clarify.

He was in V-Fib, You shocked him at 360J? Right off the bat? And that converted him to PEA, but he had pulses? You should have gone through the 200J, 300J, 360J on a Monophasic Defibrillator or the 120J, 150J, 200J on a Biphasic Defibrillator. Maybe clarify for me because on the last post you said he converted to a First Degree Heart Block, which also isn't PEA. Thanks.

Most of this has already been said, but you are right about bagging and doing compressions at the same time. On a non-intubated patient, you do cycles of 30:2 -or- you can leave out the bagging and just compress at 100 compressions/minute. On an intubated patient, you compress and ventilate at the same time, 100 compressions/minute and 12 ventiltions/minute.

Second, as MedicRN pointed out, this treatment was based on the new guidelines for ACLS. Stacked shocks have been eliminated. You shock at 360J for a monophasic, 200 for a biphasic, 360J if your not sure which one you have. (That probably shouldn't happen)

Third: ANY rhythm without a pulse is PEA. (Pulseless Electrical Activity) The exceptions are of course asystole, v-fib, and pulseless v-tach. These rhythms are expected not to have a pulse. Sinus rhythm with a first degree AV block, in the absence of pulses is PEA.

Fourth: You asked if the patient was in PEA but had pulses? That's a contradiction.

[AZCEP]

The recommendation for defibrillation energy is the "maximum allowed by the device"

Most monophasic devices this means 360 joules. Biphasic energy will vary by manufacturer. Some have a maximum of 150, some 200, still others at 360 joules (Physio control Biphasic equivalent). The energy delivered will depend on the intrathoracic resistance, and the type of waveform that the device generates.

[Aussieaid]

My bad.. :roll:

I apologise for misunderstanding. I thought he was referring to the ACLS 2005 guidelines and was trying to be diplomatic. (obviously failed).

There has been a lot of confusion at a two of the places I work about how exactly the algorithms go. Seems to be a few ways to interpret some of the steps.

I also apologise if my post came across patronizing as that certainly wasn't the intent.

Anyway cheers and fingers crossed for ROSC :wink:

Aussie

[whit72]

I believe the changes in the AHA guidelines, have been influenced by the findings that there are three distict phases of cardiac arrest.

Here is a link with some information.

http://www.pubmedcentral.nih.gov/articlere...i?artid=1557436

[KSEMT122]

Well aparently I read the first post wrong. I thought you said in sequence that he went into PEA ,but with pulses. Obviously I was sitting here thinking, PEA is Pulseless Electrical Activity, So since I read it wrong I thought you were wrong. I"m familar with rhythms, so no further explaination needed. I was not familar that things changed as far as the sequence of shocks. I guess that's the problem with teaching BLS people ALS skills. In kansas we have a Defibrillator certification, which is reading ECG rhythms and defibrillation. They don't teach us ACLS, which is probably why I didn't know things changed. Thanks for the information. As far as the contradiction between PEA and pulses, YES, that's what I was pointing out, I thought that was what was said, I was wrong. Misunderstanding.

[Thunderchild145]

I'm not trying to chew your butt.. Your post just confused me.

[whit72]

woops my above post was posted in wrong thread.