BLS/ALS Defibrilation Question

[rmellish]

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

Fair enough, but your initial post was worded differently.

 

[Mountain Res-Q]

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)

What does this have to do woth anything. The question was what complications result from shocking a pregnant patient. This has nothing to do with birth defects or a question of who do we save: mother or baby. The answer isn't debatable, we shock the mother regardless of the outcome to the fetus. The question wasn't what do you do but what results will our actions have. "Mom makes the Call"????? How does the mother tell us whether or not to defibrilate her? If she is giving you advise on defibriallation A. Don't defibrilate her and B. Find a new Profession!

What's with the revival of dead threads by the newly certified?

 

[LAS46]

Fair enough, but your initial post was worded differently.

Sorry thats what I was meaning was the rhythm not the pulse.

Dustin
MFR, NREMT-B Student

 

[Melbourne MICA]

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 defibrillated? 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?

Electricity does not travel in a linear manner. It travels between poles of conductance via the shortest path with the least electrical resistance.

As your AED pads are placed, axilla pad and sternum pad, it will find the fastest path of least resistance between them. If you touched one pole of a high voltage current to your arm you would not shocked - it needs the other (neg or post) for current to flow. This is called the potential difference.

I don't know a great deal about impedance but it is a take on electrical resistance and the calibration of the device relative to the resistance of tissues.

As the fetus is not between the poles it will not be electrocuted.

As regards picking up the baby's pulse does your AED do that or examine the electrical activity of the heart? If it does how is it picking it up by sound, vibration or electricity? And as your AED is a monitoring device how does it accomplish this? - By measuring electrical impedance between the poles ie the electrodes (pads).

I can't speak to any great knowledge on the different brands of AED's and how they differ but the electrical principles are the same for all. And there must be an ex sparkie amongst the guys out there who can fill us all in.

One other thing - if you have to defib (sync) a guy in VT for example - with a pulse or where you can't pick one up - who has a pacemaker - where do you put the pads and why? What will happen (or not happen) to the pacemaker depending on where your pads are placed?

If we had a pt in VT with a pulse and it was the case that defib/sync fries pacemakers irrespective of where you placed your pads what would the pt be left with with after a successful sync out of VT?

I guess we have to be careful about how we setup for defib/sync with AED or manual mode monitor defibrillator - especially where you put the two Pads (poles) for the zap to go between.

As the old saying goes - never come between moving electricity and its destination!!!

MM

 

[Melclin]

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?

R/r 911

It's not separately grounded as opposed to the mother (such as say a person touching the mother's body would be). Its no providing any more appealing a path for the electricity to follow to ground than the mother is. That's what I was getting at anyway, but I'm not even sure if u were aiming your comment at me.

As far as the electricity traveling from pol to pol (MelbMic), electricity will travel to wherever the greatest potential difference lays (as I understand it from highschool physics). The defib creates a greater difference across the two pols, relative to the resistance encountered, than the difference between the defib and the earth or anything else(hence why the shock doesn't just go straight to the ground, I assume). However, if the resistance is changed in a specific spot, it changes the equation, and the electricity will travel that way instead (arching over wet skin, bubles under defib pads, OR TOUCHING A PERSON WHILE DEFIBING). I have bugger all to base this on, but it seems like the presences of a pocket of fluid full of charged molecules, like amniotic fluid, near the pads might provide a more appealing path to ground, or the other pole. Perhaps lessening the effectiveness of the defib and maybe harming baby?

Its all purely academic, obviously, as I said, if mum needs some sparks, she ganna get them, but its got me interested.

MelbMica: if someone was using an AED, I don't know that they would be treating more complex rhythms than VF/VT, unless my understanding of AEDs is off. When I did my semi auto training last year on the old Zolls, the only rhythms were VF and pulseless VT (if they have a pulse/conscious, its MICA's business, as is my understanding from the CPGs).
You other blokes who use AEDs: are there new fangled ones that do more than pulseless VT/VF? I thought that if u were using an AED and not a manual defib, your scope of practice wouldn't include dysrhythmias with a pulse/concious. My experience of AEDs is those used by people with very little medical training (firefighters, lifesavers, security guards). Is this not always the case?

 

[Melbourne MICA]

MelbMica: if someone was using an AED, I don't know that they would be treating more complex rhythms than VF/VT, unless my understanding of AEDs is off. When I did my semi auto training last year on the old Zolls, the only rhythms were VF and pulseless VT (if they have a pulse/conscious, its MICA's business, as is my understanding from the CPGs).

Absolutely. I was just trying to get across the idea about electricity going along a set pathway determined by electrical conductance between poles. If you placed the pads on top of a pacemaker you would fry it because it is now inside the elctrical pathway when discharged.

If the pt was in say VT and needed to be synced by an ALS crew you can do it without frying the pacemaker provided you place the pads correctly. I'm aware an AED can't be used for this. I was following on from the original enquiry about the safety of an unborn when defib is happening by using a couple of examples to demonstarte the point. Sorry for any confusion.

I guess the overall point when using the juice is to handle with care. Done correctly and safely no worries.

MM

 

[Melclin]

Absolutely. I was just trying to get across the idea about electricity going along a set pathway determined by electrical conductance between poles. If you placed the pads on top of a pacemaker you would fry it because it is now inside the elctrical pathway when discharged.

If the pt was in say VT and needed to be synced by an ALS crew you can do it without frying the pacemaker provided you place the pads correctly. I'm aware an AED can't be used for this. I was following on from the original enquiry about the safety of an unborn when defib is happening by using a couple of examples to demonstarte the point. Sorry for any confusion.

I guess the overall point when using the juice is to handle with care. Done correctly and safely no worries.

MM

Oh my bad. I just read through it quickly and thought you just had a decidedly odd way of talking about the organic pacemaking sites in the heart->> more complex dysrythmia analysis. Yeah I missed the point completely.

But the argument about the path of conduction offering less resistance through amniotic fluid still stands. And the grounding issue, for whoever was having a go at that.

And on a side note, am I right in thinking VTs with a pulse are not an ALS issue (other than calling MICA). Seems like it would be frustrating being a QAP and sitting on my hands while a person sat there in a wide complex VT or VT with a pulse. Seems to me with my limited education that a serious VT with a pulse will probably soon degenerate into a non perfusing VT and then VF. Do us ALS guys have to sit on our hands (while transporting/waiting for MICA) until we loose a pulse? Sorry guys, don't mean to hijack the thread with our Victoria talk.