BLS/ALS Defibrilation Question

[Mountain Res-Q]

So, I was watching a old episode of HOUSE at my parents house when my mom asked me a question HOUSE-related that I couldn't answer completely.

Pregnant woman (5 months) arrests. V-Fib. They "shock" her back to life. "All hail House the Great!"

The question is: What effect (if any) is ther to the fetus if a pregant woman is defibrilated? We don't touch the patient becasue of the potential for us to be shocked (maybe into v-fib), so if we will not be attched for safety reasons, what happens to the "person" still attached via an umbical cord?

P.S. Obviously the alternative to not defibrilating the mom is not an optio So I am not looking for a justification to shock / not to shock, just a response as to the effects on the fetus from a knowledgable source. r/r911, you out there?

 

[Melclin]

Seems to me that without the shock mum will die and so will baby. With the shock, mum might live = baby might live. So it's a no brainer from that perspective.

Also, you try not to touch the patient because you might provide a more appealing route for the electricity to follow to ground. Seeing as though baby isn't grounded, it wouldn't be giving the electricity any options other than paddle to paddle. So I can't see how baby would cop any sparks.

That being said, it couldn't possibly be good for baby to have mum defibed. Extreme muscle contractions, physiological changes from the electricity, the drugs involved -- This on top of the fact that mum is already sick enough to be getting defibed in the first place. I wouldn't wanna be the kid.

VF/VT aside, with other rhythms that leave more options open (SVT for eg.) I'd be interested to know if electrical of chemical cardioversion is best for pregnant women.

 

[Ridryder911]

Ditto to Melcin. Mother comes first as she is the "life support system" for the fetus.

R/r 911

 

[Scout]

Can anyone give exact detial on what the shock actually is. assume AED, if it varies between AED's will you provide detials of which AED the stats refer to.

Volts, AC/DC, lenght of pulse etc


Sorry about the hijack Mount.

 

[Mountain Res-Q]

MY GOD, did no one read my entire first post?

Obviously you are gonna shock! As I SAID: "Obviously the alternative to not defibrilating the mom is not an option. So I am not looking for a justification to shock / not to shock, just a response as to the effects on the fetus from a knowledgable source."

Because the baby is not grounded technically, will the baby be fine... or does the potential for killing the fetus exist? Reseach, experience, atticles... Just looking to expand my education a little. -_-

 

[rmellish]

MY GOD, did no one read my entire first post?

Obviously you are gonna shock! As I SAID: "Obviously the alternative to not defibrilating the mom is not an option. So I am not looking for a justification to shock / not to shock, just a response as to the effects on the fetus from a knowledgable source."

Because the baby is not grounded technically, will the baby be fine... or does the potential for killing the fetus exist? Reseach, experience, atticles... Just looking to expand my education a little. -_-

Relax...

I don't have anything to back this up, but think of the fetus as another internal structure. The intestines don't normally have defibrillation current passing through them...why? Because the shock would from the negative to the positive defib pad. (Monophasic) I can't speak intelligently on a biphasic defibrillation. If the pads were placed correctly, the heart would be in the path of this current, and if all goes as planned, it's effect would be isolated to this area.

Or at least that's my best guess....

 

[Mountain Res-Q]

Relax...QUOTE]

I am Relaxed... I've spent my morning testing whether Ketamine provides the same level of analgesia as Morphine... http://www.emtlife.com/showthread.php?t=12330 :wacko:

Good susposition though, the differnece I see would be that your intestine doesn't have it's own independant electrical system with it's own developing circulatory pump.

 

[rmellish]

Relax...QUOTE]

I am Relaxed... I've spent my morning testing whether Ketamine provides the same level of analgesia as Morphine... http://www.emtlife.com/showthread.php?t=12330 :wacko:

Good susposition though, the differnece I see would be that your intestine doesn't have it's own independant electrical system with it's own developing circulatory pump.

That really wasn't what I was getting at. I'm supposing that the current is more or less linear, and passes through whatever structures are in its path.

 

[Mountain Res-Q]

That really wasn't what I was getting at. I'm supposing that the current is more or less linear, and passes through whatever structures are in its path.

True, but how much, if any, of the shock escapes that liner path and travels along our electrical system? Does the probablity of passing through the nerves coursing through/near the uterus or placenta (and then the fetus) exist, and what if any damage could it do to the fetus? I would like to think that the shock would have no bearing on the fetus adn I wouldn't withhold defibrilation on a pregnant woman (or man), but it would be nice educationally-speaking to know.

The day I stop learning is the day I need to get out of medicine...

 

[exodus]

Well if the mom is going to die, the baby is going to die... Save the mom eff the baby.

 

[Mountain Res-Q]

Well if the mom is going to die, the baby is going to die... Save the mom eff the baby.

Once again, not the question! It's not a "What would you do" but a "what will be the outcome when I do it" question.

 

[gicts]

Once again, not the question! It's not a "What would you do" but a "what will be the outcome when I do it" question.

the baby would shoot out and disappear

 

[Mountain Res-Q]

According to “Cardiac Arrhythmias” by Phillp J. Podrid and Peter R. Kowet (2001):
“Electrical cardioversion has been used in pregnancy and is well tolerated. Fetal Monitoring is recommended immediately after cardioversion, although the risk of induction of fetal arrhythmias appears to be minimal, perhaps because of low electrical energy reaching the fetus or high defibrillation of the fetal heart.

Likewise, “Obstetric & Gynecological Emergencies” by Mark Pearlman, Judith E. Tintinalli, Pamela L. Dyne (2003) reads:
“Although special cardioresuscitative medications (i.e. epinephrine) have theoretical consequences, use of these medications is justified in the critically ill pregnant patient. Likewise, defibrillation should be performed using the same indications as in nonpregnant patients. Reports do exist of cardioresuscitative medications and electrical cardioversion being successfully used in pregnant patients with no discernable adverse effects on mother or fetus.”

The general thought from what I was reading, from other sources as well, is that “Defibrillation transfers no significant current to the fetus”. While I am not ACLS certified, according to one site, ACLS textbooks mention using “a biphasic defibrillator (when you have the choice) because they achieve better results with a lower shock. If you only had a monophasic defibrillator, they said they might try to start the first shock with a higher voltage (300J in stead of 200J) in the hopes that you get a desired result in one shock (verses the 3 stacked.... you would hopefully only have to shock once).” They also suggested shocking anterior to posterior. For those who use only AED’s, we can try anterior/posterior, but are unable to change the voltage. The end result is, of course, that we will always shock a shockable rhythm. Mom dies = Baby dies anyway. Take the chance with the knowledge that complications to the fetus are unlikely if we shock, complications to the fetus are near 100% if we don’t.

 

[Melclin]

Seems to me that without the shock mum will die and so will baby. With the shock, mum might live = baby might live. So it's a no brainer from that perspective.

I was agreeing with you, man. I was just going through the motions, thinking out loud.

 

[Ridryder911]

MY GOD, did no one read my entire first post?

Obviously you are gonna shock! As I SAID: "Obviously the alternative to not defibrilating the mom is not an option. So I am not looking for a justification to shock / not to shock, just a response as to the effects on the fetus from a knowledgable source."

Because the baby is not grounded technically, will the baby be fine... or does the potential for killing the fetus exist? Reseach, experience, atticles... Just looking to expand my education a little. -_-

Okay..chill out. It does not really matter does it? Baby not grounded, what planet are you on? Hmm... let's see floating in aminotic fluid, connected by tissue. Yeah, I say it well grounded and yes will recieve the shock. So?

Dead mom=dead baby. Yes there maybe effects and again there maybe none. Will not know until post delivery if that is possible. Then the differential of was it related to inneruterine hypoxia or r/t the defibrillation. Many have received being zapped and lived. I have by ignorant partners, nothing I would recommend but the circumstance leaves no other option.

Clarrification on depending gestation age, if the fetus can be viable for an emergency induction or C-section or mother stable enough to leave alone.

R/r 911

 

[MSDeltaFlt]

So, I was watching a old episode of HOUSE at my parents house when my mom asked me a question HOUSE-related that I couldn't answer completely.

Pregnant woman (5 months) arrests. V-Fib. They "shock" her back to life. "All hail House the Great!"

The question is: What effect (if any) is ther to the fetus if a pregant woman is defibrilated? We don't touch the patient becasue of the potential for us to be shocked (maybe into v-fib), so if we will not be attched for safety reasons, what happens to the "person" still attached via an umbical cord?

P.S. Obviously the alternative to not defibrilating the mom is not an optio So I am not looking for a justification to shock / not to shock, just a response as to the effects on the fetus from a knowledgable source. r/r911, you out there?

I'm willing to bet noone knows for 100% sure. I can only come up with about two ways anyone might find out just how much current a fetus will received or have received during countershock therapy.

1. Place an envitro electrode on the fetus and then shock the mother with everything you've got. Yeah, not gonna happen.

2. Fetal autopsy after multiple attempts on defibrillating the mother. Personally I just don't think it's been done yet.

That would be why those quotes you posted did not state for any certainty. I'm with your posted authors. The effects would probably be minimal. Rid is also correct in my opinion, as is I believe is yours. It's semmantics. But good question though.

 

[LAS46]

My question is... would the AED pick up a pulse from the fetus and then if that is the case then the AED will not shock...

Is this the case?

Dustin
MFR, EMT-Basic (+) Student

 

[DV_EMT]

My fiancee (the RN) and I were discussing this the other day actually

we figured out a few things about the potential for death during delivery.

1. does natural selection (or God) choose who is to live and who is to die? after all, look at NICU babies. are we sure that they are going to be happy healthy people when they grow up... or are they going to have defects like cystic fibrosis, or down syndrome, or or or.

2. Who's life do we save (Playing God). there's 4 outcomes. both live, both die, mother lives/baby dies or vice versa. In my opinion. The mother is most likely healthy and to risk her death for an unknown baby's outcome is selfless. My opinion is that i'd put money on someone who i know is going to be ok as opposed to putting money on a baby that could potentially die.

then again, there are people who like to gamble.


So it really depends...but in the end... mom makes the call (unless she can't due to complications)

 

[rmellish]

My question is... would the AED pick up a pulse from the fetus and then if that is the case then the AED will not shock...

Is this the case?

Dustin
MFR, EMT-Basic (+) Student

Don't confuse electrical activity with a pulse. Remember the AED will evaluate the heart's electrical activity against the two rhythms it is programmed to shock. The AED cannot determine if the patient has a pulse.

 

[LAS46]

Don't confuse electrical activity with a pulse. Remember the AED will evaluate the heart's electrical activity against the two rhythms it is programmed to shock. The AED cannot determine if the patient has a pulse.

I understand that but if the AED detects PEA then it will not shock, so if you have a fetus who's heart is still beating then it may pick that up as PEA or even as a rhythm and will not let you shock....

Dustin
MFR, NREMT-B Student