The Skinny on Defibrillation - 150J, 200J, 300J or 360J? Biphasic or not? Waveform?

Hockey

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I'm used to Zoll but here at work we have Lifepak 12's.

I was out playing with it and noticed when I went to change the energy setting, it said Biphasic. However...it allowed me to turn the energy up to 360j.


Why? What? Huh?

I have the manual but I can't really find anything about this
 
lightsandsirens5

lightsandsirens5

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Hockey said:
I'm used to Zoll but here at work we have Lifepak 12's.

I was out playing with it and noticed when I went to change the energy setting, it said Biphasic. However...it allowed me to turn the energy up to 360j.


Why? What? Huh?

I have the manual but I can't really find anything about this
Click to expand...

360J Biphasic? Woooooooo!!!!!! That'll toast them!!!

Sorry I don't know anything about LPs. We use Zolls as well.
 
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Hockey

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lightsandsirens5 said:
360J Biphasic? Woooooooo!!!!!! That'll toast them!!!

Sorry I don't know anything about LPs. We use Zolls as well.
Click to expand...

Yeahhhh

I am uploading a video of it so we'll see


EDIT TO ADD VIDEO

[YOUTUBE]llfTIr33GU0[/YOUTUBE]
 
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socalmedic

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zoll and physio-control use two different types of biphasic therapies, zoll is biphasic truncated waveform. physio-control uses biphasic rectolinear wavecorm. basicly what happens is zoll will apply a constatn 200j throughout the shock (approx. 10ms) while physio will deliver a peak of 200j then taper off, which is why they increase the current to a max of 360j, to increase this peak current.
 
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Hockey

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socalmedic said:
zoll and physio-control use two different types of biphasic therapies, zoll is biphasic truncated waveform. physio-control uses biphasic rectolinear wavecorm. basicly what happens is zoll will apply a constatn 200j throughout the shock (approx. 10ms) while physio will deliver a peak of 200j then taper off, which is why they increase the current to a max of 360j, to increase this peak current.
Click to expand...



All great but if your protocols only allow for 200j biphasic, then you aren't truly giving the patient the best care? no?
 
socalmedic

socalmedic

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Hockey said:
All great but if your protocols only allow for 200j biphasic, then you aren't truly giving the patient the best care? no?
Click to expand...

your medical director should review what kind of waveform you have and adjust as necessary. which is why AHA says "for biphasic, use manufacture recommended energy setting". 200 max for zoll, 200, 300, 360 for LP. due to the different waveform algorithm 200j from the zoll delivers about the same total energy as 360j for the LP. i am un familiar with the Phillips.

here is a similar research paper from zoll.
 
M

medicdan

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LP 12s are also used outside of EMS, especially in hospitals (some like it on code carts, others use them in the OR, etc), so even if it's not prehospital protocol, it may be within hospitals.
 
mikie

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Biphasic Question

What is your dosing for biphasic (adult) defibrillation? We are being instructed the 200-300-360J for our new LP15. I thought that was for monophasic defibs. We currently have LP12 and have always been escalating the 200-300-360J way. Our new LP15 (biphasic; not 'in service' yet) goes to 360J but is that the correct amount of joules to be defibrillating? We are being instructed to continue defibrillating via escalation.

I read it was 120-200J (or manufacturer specific). If it is 120-200J, what are the increments/are there any?

And correct me if I'm wrong (reading this from another thread)- biphasic is AC current when defibrillating?
 
STXmedic

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It's 200J or monitor recommendation. So basically it's monitor dependent. The Phillips I use do 200J with a little room to increase if necessary.
 
MedicBrew

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mikie said:
What is your dosing for biphasic (adult) defibrillation? We are being instructed the 200-300-360J for our new LP15. I thought that was for monophasic defibs. We currently have LP12 and have always been escalating the 200-300-360J way. Our new LP15 (biphasic; not 'in service' yet) goes to 360J but is that the correct amount of joules to be defibrillating? We are being instructed to continue defibrillating via escalation.

I read it was 120-200J (or manufacturer specific). If it is 120-200J, what are the increments/are there any?

And correct me if I'm wrong (reading this from another thread)- biphasic is AC current when defibrillating?
Click to expand...


The way it was explained to me the LP15 measure the impendence, just because you see 360j on the screen, they may or may not recieve that much. We also still use the escalating dose, it's up to your M.D.

http://circ.ahajournals.org/content/97/16/1654.full
 
Epi-do

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We no longer use increasing settings, but just go straight to 360j. The way the biphasic stuff was explained to me is the same as what MedicBrew said. Even though the monitor is set at 360j, that doesn't mean they are getting 360j. The monitor determines how much they actually need, and that is what is delivered.
 
MasterIntubator

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Ours are dictated by the manufacturers recommendations.

ZOLL holds the proprietary rectilinear biphasic waveform defib, and LP has the truncated waveform. Each company claims thiers is the bomb-diggity, but knowing a few things about the sine waves and physiology as well as doing some homework and studying on the comparison..... the rectilinear is superior, and ZOLL knows it. That is why 200j is the dose across the board for ZOLL. And LP still recommends 200J-300J-360J with thier biphasic machines.

Google some of those key words... neat info out there.
 
DrankTheKoolaid

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Philips MRx is 150j
 
18G

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PA State wide ALS protocols call for 360j for ALL shocks. I just took ACLS and used a Phillips monitor and that energy delivery was 150j.

It is pretty confusing. Honestly, no one really knows what the optimal dose is.
 
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