# Dual Sequential Defibrillation



## coolidge (Jan 25, 2012)

Does anyone recall reading a report/story about the use of two AEDs at the same time?  And if so, where the reference is found.....Thanks


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## NYMedic828 (Jan 25, 2012)

Why would you ever use two AEDs at the same time? There is zero reason whatsoever to support a benefit for that...

Also if this is an ALS related discussion, why is an AED being used and not a monitor :/


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## mikie (Jan 25, 2012)

Try looking up Double Sequential Defibrillation


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## NYMedic828 (Jan 25, 2012)

mikie said:


> Try looking up Double Sequential Defibrillation



Now that makes more sense to me.

That would be done using a pair of monitors though, not using AEDs.

AEDs could not possibly achieve that.


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## Shishkabob (Jan 25, 2012)

Dual device defibrillation is being used around here for refractive v-fib.  Apparently it's been showing decent results.



We had a refractive V-fibber last week that was shocked 7 times between fire and us.  Converted to asystole before we gave the dual shock a shot.


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## Medic Tim (Jan 25, 2012)

Double Sequential Defibrillation
there was an article about it in Jems or Emergency mag. last year. I cant remember which


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## Shishkabob (Jan 25, 2012)

NYMedic828 said:


> That would be done using a pair of monitors though, not using AEDs.
> 
> AEDs could not possibly achieve that.



If they were sAEDs, sure they could.  Granted it'd take some effort syncing them, but as long as you're the one that presses the button, it's good to go.



EMS world article;

http://www.emsworld.com/article/10318805/hold-the-coroner


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## mycrofft (Jan 25, 2012)

Dueling AED's?


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## NomadicMedic (Jan 25, 2012)

Thought they were doing this in Wake?


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## STXmedic (Jan 25, 2012)

Doing it down here, considerable on the third shock and beyond. Haven't personally had to do it yet, though.


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## JPINFV (Jan 25, 2012)

mycrofft said:


> Dueling AED's?









Dualing AEDs... making patients squeal like a pig since 1972.


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## bigbaldguy (Jan 25, 2012)

JPINFV said:


> Dualing AEDs... making patients squeal like a pig since 1972.



:rofl:


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## Handsome Robb (Jan 26, 2012)

For the double sequential defib how are you guys placing your pads? I started a thread about it a while back when I saw something on WCEMS website about it. They seem to put the pads next to eachother. 

I could see apex/sternum and posterior/anterior working well with the different vectors, I don't see the point of dual apex/sternum placement.


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## Shishkabob (Jan 26, 2012)

We do apex/sternum and anterior/posterior.


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## STXmedic (Jan 26, 2012)

We do apex/sternum unless it doesn't fit well on the pt, then we go front/back.

Rob: The way our Med Director explained it to me was like upping the dose of medication. If X amount of Y drug isn't working, you need to up the dose or it will continue to not have the desired effect. Especially since shocking isn't a cumulative effect between shocks. So it's not necessarily the placement and trying to affect more vectors, but upping the "dose". Now, I haven't done enough research on it to be able to determine if that's a very reasonable simile or if he was trying to explain it to me like a 4th grader. :unsure:


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## NomadicMedic (Jan 26, 2012)

It's nothing like upping the dose. It's the second, quickly delivered shock through a separate pathway terminating VF after the first shock reduces the defib threshold. It actually takes LESS energy to convert VF using the sequential shock methodology. 

http://www.ncbi.nlm.nih.gov/m/pubmed/3782643/


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## STXmedic (Jan 26, 2012)

Well I guess he was talking to me like a 4th grader  Your post prompted some quick journal searches, all of which confirmed this. Thanks n7


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## NomadicMedic (Jan 26, 2012)

PoeticInjustice said:


> Well I guess he was talking to me like a 4th grader  Your post prompted some quick journal searches, all of which confirmed this. Thanks n7



Or perhaps he doesn't understand the mechanism of action. 

It's an interesting concept. I won't be surprised when, in the future, we are issued the new LP115 with 4 pads, able to deliver sequential shocks.


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## epipusher (Jan 26, 2012)

Our service has been considering doing a study on this. They are currently working on the continuous cpr during defib.


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## Hockey (Jan 27, 2012)

Interesting for sure.  I'll forward Linus' article on as well.


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## jpmedic21 (Jan 27, 2012)

we are able to do it here. unsure of the specifics as to which conditions warrant it, but i have done it once with our advanced medic, and have heard of multiple other times its been used.


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## Shishkabob (Jan 28, 2012)

jpmedic21 said:


> we are able to do it here. unsure of the specifics as to which conditions warrant it, but i have done it once with our advanced medic, and have heard of multiple other times its been used.



I've noticed that our 80's don't do it but our APPs do.


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## jjesusfreak01 (Feb 4, 2012)

Kind of a cool concept. You figure these people are dead anyways, so the only risk is that you might save one or two a year by trying it. I believe i've seen it done once, and I don't believe it worked that time.


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## NomadicMedic (Feb 5, 2012)

jjesusfreak01 said:


> Kind of a cool concept. You figure these people are dead anyways, so the only risk is that you might save one or two a year by trying it. I believe i've seen it done once, and I don't believe it worked that time.



Are you serious? Really, the only arrest rhythm that has any measurable success in survival to discharge is VF.  If sequenced shocks can convert refractory VF, it's more than just a "cool concept". It's actually a valid, workable solution to a problem that has prevented a successful resuscitation in these type of codes.

I hate the, "they're dead anyway, you can't make them any worse" mentality.


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## Jon (Feb 9, 2012)

n7lxi said:


> Are you serious? Really, the only arrest rhythm that has any measurable success in survival to discharge is VF.  If sequenced shocks can convert refractory VF, it's more than just a "cool concept". It's actually a valid, workable solution to a problem that has prevented a successful resuscitation in these type of codes.
> 
> I hate the, "they're dead anyway, you can't make them any worse" mentality.



Well, you have to admit - it makes a good fallback line if the treatment doesn't work.

As for pad placement - I've only read of 1 pair fore/aft, and one top/bottom.

Oh, and I changed the title. Because it confused me at first.


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## jjesusfreak01 (Feb 9, 2012)

n7lxi said:


> Are you serious? Really, the only arrest rhythm that has any measurable success in survival to discharge is VF.  If sequenced shocks can convert refractory VF, it's more than just a "cool concept". It's actually a valid, workable solution to a problem that has prevented a successful resuscitation in these type of codes.
> 
> I hate the, "they're dead anyway, you can't make them any worse" mentality.



Hey hey, i'm not trying to stir up trouble here. I understand what you're saying, i'm just pointing out that refractory v-fib is a superhard rhythm to break, and it is very unlikely that these patients are going to survive. If it makes you feel any better, I think of all arrests as dead people who are probably going to stay that way, but i'm trying to get them back regardless. I love working arrests, so don't think that my opinion in this regard at all effects my efforts.


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