![]() I am talking about the patient who you have tried to defibrillate several times unsuccessfully I am talking about thinking outside the box. I am not talking about doing this on every patient with VF. Now I get it, in the scheme of evidence based medicine, case reports are amongst one of the lowest forms of evidence, but hear me out.Simultaneously press the shock button on both monitorsĪll of the above are acceptable ways to place the pads Discussion:.Ensure everyone is clear of the patient.Charge both monitors (360J for monophasic and 200J for biphasic).Using a second defibrillator, you can place a second set of external defibrillation pads next to each other, but ensure that the pads are not making contact with each other.This procedure should only be used in refractory ventricular fibrillation after multiple attempts at defibrillation and appropriate medications have been given.How do you perform dual simultaneous external defibrillation? Describe a novel approach of “high-energy” defibrillation in a patient with intractable VF after cardiac arrest.Although VF typically responds very well to the standard energies of defibrillation, maybe in patients with higher body mass index or morbid obesity we need higher energies to achieve successful defibrillation. For those of us in the trenches of the emergency department, we have to think beyond ACLS at times. For many who have heard me speak about ACLS, you have heard me say that these guidelines are created for the providers who do not perform resuscitation as part of their daily routine. What we all know is that high-quality, limited interruption cardiopulmonary resuscitation (CPR) and early defibrillation are the hallmarks of successful neurologic outcomes in OHCA. The majority of OHCA is due to cardiac etiology with the most common initial rhythm being ventricular fibrillation (VF). ![]() Even more concerning is the high mortality rate which is associated with this. More robust research is required to eliminate profound limitations and consider contributing factors to DSD.Background: Out-of-hospital cardiac arrest (OHCA) occurs in the United States at a rate of nearly 300,000 individuals per year. However, results are consistently limited by varying protocol and small study groups and DSD success is likely multifactorial.Conclusion:The current systematic literature review indicated that no confirmed association existed between DSD and improved OHCA outcomes. ![]() DSD is offered as a potentially feasible RVF treatment strategy throughout. ![]() double sequential in adult out-of-hospital cardiac arrestīackground:Refractory ventricular fibrillation (RVF) in out-of-hospital cardiac arrest (OHCA) poses a significant challenge to paramedic teams and is further confounded by an absence of specific guidance on the management of this patient category.Objective:To conduct a systematic literature review to determine whether double sequential defibrillation (DSD) improves patient outcomes in adult OHCA.Methods:Electronic searches of CINAHL, MEDLINE and AMED databases were carried out, using EBSCOhost (2017) and a subsequent filtering process.Results:Three case series and two cohort studies provided the highest category of evidence to evaluate. ![]()
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