# Bullet Vs. AED



## mikeylikesit (Jun 22, 2008)

It has been in my mind for a few nights now and i can't seem to find an answer no matter who i ask or what i search for. My question is do you think that a Bullet logged in a persons thorax between where the pads or paddles are place for an AED or manual Dfib would conduct all of the electrical current or would it bypass the bullet? my thoughts are that if a bullet is in the direct path between the electrodes then it should absorb and redirect the current coming from the defibrillator and thus never deliver the Joules to the patients heart. what do you think?


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## triemal04 (Jun 22, 2008)

Most bullets are made of lead, which is an extremely poor (read essentially non-existent) conducter of electricity.  There are some copper-jacketed bullets out there though, and copper is a great conducter of electricity.  Even with that though, the chance of there being a problem is probably pretty small.  For both it shouldn't be a problem.


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## JPINFV (Jun 22, 2008)

Where exactly would the bullet redirect to? It's not grounded nor is it charged. I see no reason for a bullet wound to contraindicate a use of an AED on a dead person.


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## seanm028 (Jun 22, 2008)

Ditto to what JPINFV said.  Even if it did conduct electricity, it wouldn't make a difference.  Think of a basic circuit; the wires don't "absorb" the electricity.  They pass it along.


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## MedicPatrick (Jun 24, 2008)

Another question is, how likely is it that a traumatic arrest would be in a shockable rhythm in the first place?

Assuming the hypothetical patient didn't, you know, pass out and fall onto a gun.


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## mikeylikesit (Jun 25, 2008)

MedicPatrick said:


> Another question is, how likely is it that a traumatic arrest would be in a shockable rhythm in the first place?
> 
> Assuming the hypothetical patient didn't, you know, pass out and fall onto a gun.


Such trauma can easily set off arrhythmias, i have seen it quiet a few times.


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## JPINFV (Jun 25, 2008)

penetrating trauma arrest!=blunt trauma arrest


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## Ops Paramedic (Jun 25, 2008)

I agree with what has been said with regards to the electricity and conducting.  Electricity will follow the path of least resistance, and as mentioned lead has a lot of resistance.  Electricity also travels through fluid filled with salt/electrolytes with relative ease, and there is a lot of that in us.  Knowing that there are many different types of projectiles, chances are that you will not be able to find out if it was a copper or lead slug, until such a time as it has been surgically removed.

Even ,if you suspect, due to the location of a wound (not differetiaing between entry and exit), that projectile may be lodged in the direct path of the current will travel, once again, you will not know, as you can not see the path the current will travel, nor can you see where the projectile is lodged.

My treatment would not alter from the normal.  Expect if you can visualise or palpate the projectile directly under the skin surface, whereby i will just adjust the placement of the paddle or pad so that it not directly on the projectile!


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## eggshen (Jun 30, 2008)

Best bet would be not to shock the traumatic arrest in the first place.

Egg


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## BEorP (Jun 30, 2008)

eggshen said:


> Best bet would be not to shock the traumatic arrest in the first place.
> 
> Egg



And why is that?


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## LucidResq (Jun 30, 2008)

BEorP said:


> And why is that?



Around here, protocols for AED use say "Do not use on trauma patients." 

I know that not all protocols agree. 

It seems to me that with most trauma arrest patients, using an AED would be pointless because the problem that caused the arrest in the first place will likely be completely unaffected by the shock. 

In a GSW to the chest, the cause for the arrest is probably going to be massive hemorrhage, respiratory failure or damage directly to the heart. If someone has a bullet through their aorta or they've lost 4 liters of blood, you can shock them all day long and it's probably not going to matter. If it's due to respiratory failure due to a tension pneumo or something... then maybe the AED will be beneficial... but only if the respiratory problem is being treated aggressively.

However I would definitely take into consideration with the trauma arrest patient the possibility of a medical arrest/arrhythmia causing the trauma (ie: man falls into v-fib while driving and crashes).


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## mdtaylor (Jul 1, 2008)

LucidResq said:


> Around here, protocols for AED use say "Do not use on trauma patients."



And ours reads "Do not use the AED on trauma induced cardiac arrest." as opposed to ANY trauma patient. As you pointed out, an mva could have been the result of the cardiac arrest and as such both medical and traumatic conditions must be treated.


To respond to the initial post, think of the bird sitting on the electrical wire....


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## BEorP (Jul 1, 2008)

LucidResq said:


> Around here, protocols for AED use say "Do not use on trauma patients."
> 
> I know that not all protocols agree.
> 
> ...



Nicely put. Basically the point that I was hoping to make is that there isn't necessarily something horrid about shocking someone who may be in cardiac arrest from trauma but it is rather more likely that they will not be in a shockable rhythm (or even if they are it will only be one of the reasons they are in cardiac arrest) and their best outcome will be from seeing a surgeon. This is why the protocols usually say not to bother trying and this would be the reason that we don't use the defibs on these patients. The reason though is *not* just because your protocols say so.


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## scfr3310 (Jul 17, 2008)

*traumatic arrest*

In this situation AEDs should not be used b/c of the MOI. If you think of a bullet entering the chest cavity and then becoming lodged in the lung, heart...etc.... and then you shock you can dislodge the bullet and it may it another organ... also if you look in BLS for Healthcare Providers Manual (American Heart Association), it recommends that you do CPR and NO Defib! 


Ok so i think my rant is over lol
Joel


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## JPINFV (Jul 17, 2008)

scfr3310 said:


> In this situation AEDs should not be used b/c of the MOI. If you think of a bullet entering the chest cavity and then becoming lodged in the lung, heart...etc.... and then you shock you can dislodge the bullet and it may it another organ... also if you look in BLS for Healthcare Providers Manual (American Heart Association), it recommends that you do CPR and NO Defib!
> 
> 
> Ok so i think my rant is over lol
> Joel




1. How exactly will electricity remove the bullet from an organ and force it into another? 


2.


> If an automated external defibrillator (AED) is available, turn it on and attach it. The AED will evaluate the victim’s cardiac rhythm and advise delivery of a shock if appropriate. If VF is present, note that the VF may have been the cause rather than the consequence of the trauma (eg, an automobile driver develops VF sudden cardiac arrest and when he loses consciousness he crashes the car). The victim may require further cardiac evaluation following resuscitation.


-Part 10.7: Cardiac Arrest Associated With Trauma
http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-146


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