Chest Compressions During Shock

[BASICallyEMT]

I learned today that theres research being done on how chest compressions can be continued while the AED shocks. I may be the last person to hear this in which I apologize. I myself would still be uncomfortable doing so and what about the person with the undiagnosed heart problem that receives the minor shock?

 

[DesertMedic66]

I learned today that theres research being done on how chest compressions can be continued while the AED shocks. I may be the last person to hear this in which I apologize. I myself would still be uncomfortable doing so and what about the person with the undiagnosed heart problem that receives the minor shock?

What do you mean by "the person with the undiagnosed heart problem that receives the minor shock"? Cardioversion, pacing, pacemaker shock?

 

[Medic Tim]

What do you mean by "the person with the undiagnosed heart problem that receives the minor shock"? Cardioversion, pacing, pacemaker shock?

I think he means the person doing CPR

 

[BASICallyEMT]

I think he means the person doing CPR

Correct. I'm under the impression that you can still feel the shock thats being delivered but its more of a tingling sensation. And I guess they are looking into thicker gloves used specifically for CPR

 

[Aprz]

Old news, and I read on millshaven command I think that they probably don't recommend it because it's not as safe as it once thought to be by the people that thought it might be safe, lol. Might have been another blog. I'll try to find the link later, but I'm about to eat dinner.

 

[Medic Tim]

I was hands on for a shock a couple years ago. I felt a little tingle and that was it.

I have heard some are doing this now and double gloving. I would want to see some more research before I intentionally do it.

 

[Handsome Robb]

There were a few places studying "hands on defibrillation" and they said generally all you feel is a "small tingle or jolt" then recently I read something that they've come out and said that it isn't safe. Most of the time all you get is a little tickle but I guess they had incidents of providers receiving a dangerous amount of energy.

I'll see if I can find the link.

 

[avdrummerboy]

Just ask anyone who has ever failed to 'clear' a patient, or do it too slowly, and they'll tell you why not to do this!

 

[Tigger]

Just ask anyone who has ever failed to 'clear' a patient, or do it too slowly, and they'll tell you why not to do this!

Well not quite. As I recall anteriolateral pad positioning is required so you're not placing your hands between the current. Getting welded across the room is obviously not happening or the study would not continue to progress.

 

[Handsome Robb]

Video of it: http://www.youtube.com/watch?v=o6lMQITV5AY

What the AHA says: http://jaha.ahajournals.org/content/1/5/e001313.full

PubMed: http://www.ncbi.nlm.nih.gov/pubmed/23316286

And here is the article advocating against the safety of the procedure: http://www.medscape.com/viewarticle/828541

In a trial with cadavers, so-called hands-on defibrillation exposed rescuers to 200 to 827 volts, or 1 to 8 joules, which is more than safety standards recommend.

"The rescuer energy we measured (1 to 8 J) is not dramatically high, but it shares a waveform and frequency designed to affect cardiac myocytes. In susceptible rescuers, this could result in serious injury..."

 

[NPO]

Right now they say it's "unsafe" even though its just a tingle the amount of energy transfered to the rescuer is beyond what they have set as an acceptable maximum.

I don't see this going away. I can see some areas adapting it quickly and the industry as a whole innovating until it works.

 

[vcuemt]

Get with the times!

 

[STXmedic]

Right now they say it's "unsafe" even though its just a tingle the amount of energy transfered to the rescuer is beyond what they have set as an acceptable maximum.

I don't see this going away. I can see some areas adapting it quickly and the industry as a whole innovating until it works.

Because EMS is at the forefront of innovation...

I don't see many agencies moving to this. At least not until something more definitive comes out. While its only up to eight joules, it is still past the maximum threshold and thus viewed as a risk to the provider (and a liability to the system). If CPR is performed throughout the charging of the defibrillator, and there is a well-choreographed pause just long enough to allow to the shock to be delivered, then the effect to prime and flow should be minimal. As risk-free as this is, people still don't/won't even do this, though.

 

[Christopher]

I learned today that theres research being done on how chest compressions can be continued while the AED shocks. I may be the last person to hear this in which I apologize. I myself would still be uncomfortable doing so and what about the person with the undiagnosed heart problem that receives the minor shock?

You should not perform CPR during the analyze or shock period with most AED's.

Not because of any safety reasons either.

There is currently too much variability in the algorithms related to shock analysis and you cannot rely on your AED to allow you to do those compressions.

Now, if we'd like to talk about rescuer safety during HOD:

1. It has been shown in case reports to produce minor physical sensations
2. It has been shown in cadaver studies to be within "safety limits"
3. It has been shown in cadaver studies to be "outside safety limits"
4. If wearing nitrile gloves or using a barrier, it has been shown to be very "safe"

If you've got a puck on the chest, say Zoll's CPR pads or Philips Q-CPR or Physio's True-CPR; then you're Ok.

 

[STXmedic]

Redacted: misread.

 

[NPO]

Because EMS is at the forefront of innovation...

I don't see many agencies moving to this. At least not until something more definitive comes out. While its only up to eight joules, it is still past the maximum threshold and thus viewed as a risk to the provider (and a liability to the system). If CPR is performed throughout the charging of the defibrillator, and there is a well-choreographed pause just long enough to allow to the shock to be delivered, then the effect to prime and flow should be minimal. As risk-free as this is, people still don't/won't even do this, though.

I don't tho I ems will innovate it, and as far as I know none of the studies are done in ems either.

I think that university based medical systems will innovate it, and it will trickle down, like most things we do.

 

[NPO]

Because EMS is at the forefront of innovation...

I don't see many agencies moving to this. At least not until something more definitive comes out. While its only up to eight joules, it is still past the maximum threshold and thus viewed as a risk to the provider (and a liability to the system). If CPR is performed throughout the charging of the defibrillator, and there is a well-choreographed pause just long enough to allow to the shock to be delivered, then the effect to prime and flow should be minimal. As risk-free as this is, people still don't/won't even do this, though.

I don't think I ems will innovate it, and as far as I know none of the studies are done in ems either.

I think that university based medical systems will innovate it, and it will trickle down, like most things we do.

 

[NomadicMedic]

I use the Lucas device while shocking.

 

[46Young]

Same here, with the Lucas II.

 

[Christopher]

I use the Lucas device while shocking.

Same here, with the Lucas II.

I assume there is a pause somewhere for a rhythm check?