Hands On Defibrillation

TheLocalMedic

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Has anyone else seen this video? http://medicscribe.com/2012/12/hands-on-defibrillation/

Very interesting, and potentially game changing if we start doing this. I did accidentally get a little zap once as an EMT, and although it was startling it certainly didn't stop me from jumping right back on the CPR. What are your thoughts?
 

jrm818

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Has anyone else seen this video? http://medicscribe.com/2012/12/hands-on-defibrillation/

Very interesting, and potentially game changing if we start doing this. I did accidentally get a little zap once as an EMT, and although it was startling it certainly didn't stop me from jumping right back on the CPR. What are your thoughts?

were you using paddles or pads? Supposedly the paddles have a higher risk for zappage, only the pads are safe for hands-on.
 
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TheLocalMedic

TheLocalMedic

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I got zapped with pads in place. Like I said, it startled me, but didn't hurt me.
 

WTEngel

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I have heard, anecdotally, that some places are using insulated pads (similar to pot holders, made from silicone I think) that the person places on the chest, and then does compressions over. This way they eliminate the leakage current...

I think we will be doing continuous compressions within one to two revisions (2015 or 2020) even during defibrillation.
 

Christopher

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Interesting timing, off forum a number of us have had a long discussion on the topic that eventually included Dr. Scott Youngquist's experience with HoD at Salt Lake City Fire.

I personally have had it done numerous times while I've been on the chest and can report feeling nothing but an "odd" sensation. I am not sure if it really happens or if it is mental bias that I have the feeling (since you feel them jerk).

With the next generation of monitors including an accelerometer pad on the chest, I think you can safely say "it'll be Ok".

Physio-Control says no, EP lab experience says "if you'd like", real life implementation at SLC showed, "HOD may be safe for providers but not administrators!" (Youngquist, personal communication)

There has been work on resuscitation blankets in the past that provide a insulator/dielectric layer to keep rescuers "safe" from (as the authors put it) "annoying" shocks.

All-in-all I think continuous compressions are worthwhile, and if you believe the risk:benefit ratio is <1, then it is reasonable to provide them during defib.

(References)
 
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Christopher

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I have heard, anecdotally, that some places are using insulated pads (similar to pot holders, made from silicone I think) that the person places on the chest, and then does compressions over. This way they eliminate the leakage current...

Even with an insulator between the patient and rescuers, they will still receive leakage current due to the high voltage at the skin. Advances in the "resuscitation blankets" use a conducting layer, sandwiched between two non-conducting layers, which is connected to the patient or to a reference ground on the defibrillator. Even with this in place it merely changes the shocks from "annoying" to "not annoying".
 

mycrofft

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This dovetails into my looking around earlier this year about "minor shocks" (in ref to obstacle races with participants being shocked on purpose, repeatedly), thanks. Anecdotes from here and private sources said the same.

As a card-carrying Atrial Fibrillation pt, I would hesitate to experience anything like that. Never did like "mild electric shocks" even before that.

I teach my students to compress while the AED pads are being applied and until the machine or its operator says to stop for analysis. I then teach them to dive back in (hands were poised during hiatus) before the machine says to. Maybe lose, at best, three to five compressions? More if the analysis is delayed, but the analysis is necessary with an automated defib. I specifically and emphatically teach them there is NO residual charge once the shock is administered.

dvbones54.jpg


. They always seem to want to stop and watch once the rescue breaths are on board, though, so I drill them not to do that.
 

d_miracle36

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I tried to get this approved for me to try in our service, but now we have the lucas so we can just shock away.
 

Jon

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I've got the Lucas at my 911 job- so I don't need to do this.

Interestingly enough, AMR's Dr. Racht sent out a memo recently saying "we aren't recommending this at this time". There's been more talk because of that memo than before - no one but me knew what it was referencing.
 

epipusher

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Our service has implemented it on a voluntary basis.Its up to the individual doing compressions at the time if they want to stay hands on with gloves on. As far as Afib goes, our medical director has it and tested hands on with both gloves on and off with no problems.He has performed it multiple times as well.
 

mycrofft

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Our service has implemented it on a voluntary basis.Its up to the individual doing compressions at the time if they want to stay hands on with gloves on. As far as Afib goes, our medical director has it and tested hands on with both gloves on and off with no problems.He has performed it multiple times as well.

Can you re-describe the atrial fib scenario diagrammatically?I'm imagining a guy with A-fib (marginally shockable and not as an emergency) being defibbed and compressed by ...himself? Friends?;)
I always had Propofol, so I can't remember who was holding the paddles...might have been Dexter for all I now.
 

epipusher

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Can you re-describe the atrial fib scenario diagrammatically?I'm imagining a guy with A-fib (marginally shockable and not as an emergency) being defibbed and compressed by ...himself? Friends?;)
I always had Propofol, so I can't remember who was holding the paddles...might have been Dexter for all I now.

One of our medical directors has AFib and stated to us that he continues compressions during defib with no worries or concerns.Again,it is optional and up to the individual.I personally have yet to perform it, but have seen coworkers and the md do it via a training video.

edit:unable to find a usable picture
 
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mycrofft

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One of our medical directors has AFib and stated to us that he continues compressions during defib with no worries or concerns.Again,it is optional and up to the individual.I personally have yet to perform it, but have seen coworkers and the md do it via a training video.

edit:unable to find a usable picture

Got it.


young-frankenstein-1974.jpg
 

Brandon O

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As Christopher notes, we've been hamming this around quite a bit. There are a few studies which are suggestive (although certainly not definitive) that it's a safe practice, and one which suggests it may not be. There are also anecdotal reports from a number of practitioners (various levels, but mostly attending physicians) who have been doing this regularly for some time now, so far without any hair-raising explosions. Salt Lake City (Youngquist's operation) is the first area I've seen to explicitly recommend (although not require) it.

But obviously, the gap between "probably okay" (i.e. much of what we do every day) and "okay for 100% of providers, we're going to make it a top-down policy" is pretty big; in fact even SLC has temporarily removed the "option" due to an abundance of caution.

This whole business very closely mirrors C-spine and various other practices, where everyone has a horror story about a "friend of a friend" who died horribly due to going against the grain, so I think "abundance of caution" is probably going to be the name of the game for a while. However, on an individual provider level, I think it's very much within the realm of reason, especially if you double- or triple-glove, have some kind of interposed feedback device, or maybe get one of those mats. (Remember that the path your body offers to that electricity should, for the most part, always be far less appealing than the short arc between the pads.)

If you're not doing it, I still hope that you're compressing right up through the charging phase and only coming off the chest for 1-2 seconds at most for the actual shock. The trouble is that this is often much longer in actual implementation by the rank and file.
 

mycrofft

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Anone have a nomogram of central pressure loss after compressions are stopped? Just asking.

Actually, as far as anecdotes, I have yet to read anything or talk to anyone who had an adverse health event due to second hand defib. If you aren't grounded, plus gloved (insulated), then the charge ought not to really affect you much at all.

As for me, since even caffeine is not good, I'm passing. I'll do insufflations.
 

Brandon O

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mycrofft

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disregard reply

It's the browser's fault:wacko:
 
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mycrofft

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Brings home the phrase "circulatory collapse" doesn't it? Thanks!!!!! Seems to pick back up rapidly, though. Or am I missing something?
 
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