Someting this new Medic never heard of

Macari

Macari

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So I’m a new Medic and I was talking to a Medic of probably 2-3 years about the code she had the day before.
Bla bla bla... pt in PEA... bla bla bla... shocked 3 time.
:unsure: Wait a minute now, shocking PEA? Is this a common practice or just a foolish Medic?

Thanks
Tony
 
Macari said:
So I’m a new Medic and I was talking to a Medic of probably 2-3 years about the code she had the day before.
Bla bla bla... pt in PEA... bla bla bla... shocked 3 time.
:unsure: Wait a minute now, shocking PEA? Is this a common practice or just a foolish Medic?

Thanks
Tony
Click to expand...

No. You do not shock PEA under any circumstances.

Sounds like a desperate, panic/ignorant move.
 
Per AHA ACLS guidelines PEA is a non-shockable rhythm. Maybe she was trying it as a last ditch effort before declaring the guy?
 
Aidey said:
Per AHA ACLS guidelines PEA is a non-shockable rhythm. Maybe she was trying it as a last ditch effort before declaring the guy?
Click to expand...

Maybe ruling out fine VF. But if that was the case thats what she should have claimed.
 
Most PEA rhythms are idioventricular in nature. If they wanted to make the rhythm into aystole, this is definitely they way to do it... but, its not the appropriate treatment. I suggest that before advising treatment; they may want to know the appropriate standard of care.

R/r 911
 
Macari said:
So I’m a new Medic and I was talking to a Medic of probably 2-3 years about the code she had the day before.
Bla bla bla... pt in PEA... bla bla bla... shocked 3 time.
:unsure: Wait a minute now, shocking PEA? Is this a common practice or just a foolish Medic?

Thanks
Tony
Click to expand...
I shock everything.





Just Kidding :P
 
Macari said:
So I’m a new Medic and I was talking to a Medic of probably 2-3 years about the code she had the day before.
Bla bla bla... pt in PEA... bla bla bla... shocked 3 time.
:unsure: Wait a minute now, shocking PEA? Is this a common practice or just a foolish Medic?

Thanks
Tony
Click to expand...

According to ACLS, if a patient is in PEA, you are to do 5 cycles of CPR (while giving Epi(/Atropine) or Vasopressin).

After 5 cycles of CPR, you are to identify the cardiac rhythm. If it's shockable, you ARE to shock it.
 
thanks, had a feeling she was wrong. She did transport and the hospital and on arrival they found aystole. Go figure

Tony
 
I seem to recall some long ago deal with WITNESSING a pt go into PEA and shocking..but either way, it's obsolete now.
 
Macari said:
thanks, had a feeling she was wrong. She did transport and the hospital and on arrival they found aystole. Go figure

Tony
Click to expand...

So PEA is not shockable but she did not hurt anything by doing it. Perhaps she was not sure and just saved herself the "what ifs" that would go through her head later on..
 
Vonny said:
So PEA is not shockable but she did not hurt anything by doing it.
Click to expand...
How do you figure that? She eradicated the rhythm, forever erasing all hope of chemically converting it. Whether or not it would have been converted, we'll never know. But by denying the patient that chance, I and any jury would agree that she did hurt the patients chances at life.
 
AJ Hidell said:
How do you figure that? She eradicated the rhythm, forever erasing all hope of chemically converting it. Whether or not it would have been converted, we'll never know. But by denying the patient that chance, I and any jury would agree that she did hurt the patients chances at life.
Click to expand...

I guess I was assuming that a chemical conversion was either ruled out or was not available at the time. Around where I live a chemical conversion is at least 40 minutes away.
 
Vonny said:
So PEA is not shockable but she did not hurt anything by doing it. Perhaps she was not sure and just saved herself the "what ifs" that would go through her head later on..
Click to expand...

Well, actually, she did if you want to be picky. While wasting time shocking a rhythm that gets no response from defibrillation, she could have been focusing on something that might actually save the patient.

Treating possible causes and efficient CPR. Both of these are more beneficial than anything you can do, even epi and atropine.

I know we all sometimes step out of protocol to try to save a patient, but it's a thin line between ego and negligence.
 
Shocking PEA? Meh. Can't kill a dead guy. We've tried for years. But, it's totally ACLS taboo. Yeah, yeah, they're idioventricular (:excl:usually:excl:) - so they //could// respond to electrical tx- but - never seen it - never documented - don't do it.
 
Last edited by a moderator:
Macari said:
So I’m a new Medic and I was talking to a Medic of probably 2-3 years about the code she had the day before.
Bla bla bla... pt in PEA... bla bla bla... shocked 3 time.
:unsure: Wait a minute now, shocking PEA? Is this a common practice or just a foolish Medic?

Thanks
Tony
Click to expand...

I would really like to know the bla bla bla parts, something must have made her take the action she took. 3 shocks sounds like a desperate effort. What ALS was available, how long to ALS.
 
Macari said:
... I was talking to a Medic of probably 2-3 years about the code she had the day before.
Bla bla bla... pt in PEA... bla bla bla... shocked 3 time.
:unsure: Wait a minute now, shocking PEA? Is this a common practice or just a foolish Medic?

Thanks
Tony
Click to expand...

Vonny said:
I would really like to know the bla bla bla parts, something must have made her take the action she took. 3 shocks sounds like a desperate effort. What ALS was available, how long to ALS.
Click to expand...

It was ALS that did it, according to the OP, so I'd say the wait time to ALS was zero after arrival. :P
 
Incompetence. Besides insanity or premeditated battery, there is no other possible explanation.
 
sounds like a case of shock it till you know how to work it to me, very frightening that this person is still practicing and that per the OP statements and implication of the tone of the conversation that she doesnt a) know she did anything wrong or b) doesn't care that she did something wrong. I would hope that this was turned over to QA/QI or medical officer for review.
 
Zapping PEA

Sounds like a bad idea all round - shock the pt into aystole would be the likely outcome. Fair bit of harm there. Especially if the underlying problem is at least partially correctable by other means.

What did the operator think the rhythm was more specifically? VF/pulseless VT are usually well taught and well recognised I would have thought.

MM
 
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