Difference between revisions of "Double simultaneous external defibrillation"

(Indications)
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==Overview==
 
==Overview==
In patients suffering from non-traumatic cardiac arrest who exhibit ventricular fibrillation refractory to standard defibrillation, two simultaneous shocks may be considered.  This is termed double sequential external defibrillation (DSED) and has been shown to have some effect in terminating VF<ref>Hoch DH, et al. Double sequential external shocks for refractory ventricular fibrillation. J Am Coll Cardiol. 1994; 23(5):1141-5.</ref><ref>Cabanas JG, et al. Double Sequential External Defibrillation in Out-of-Hospital Refractory Ventricular Fibrillation: A Report of Ten Cases. Prehosp Emerg Care. 2015; 19(1):126-130.</ref>, though existing data on neurologic outcomes conflict.  Several large EMS systems currently use DSED in their standing medical orders<ref>Cortez E et al.  Use of double sequential external defibrillation for refractory ventricular fibrillation during out-of-hospital cardiac arrest.  Resuscitation 2016; 108:82-6.</ref>.
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*In patients suffering from non-traumatic cardiac arrest who exhibit ventricular fibrillation refractory to standard defibrillation, two simultaneous shocks may be considered.  This is termed double sequential external defibrillation (DSED) and has been shown to have some effect in terminating VF<ref>Hoch DH, et al. Double sequential external shocks for refractory ventricular fibrillation. J Am Coll Cardiol. 1994; 23(5):1141-5.</ref><ref>Cabanas JG, et al. Double Sequential External Defibrillation in Out-of-Hospital Refractory Ventricular Fibrillation: A Report of Ten Cases. Prehosp Emerg Care. 2015; 19(1):126-130.</ref>, though existing data on neurologic outcomes conflict.  Several large EMS systems currently use DSED in their standing medical orders<ref>Cortez E et al.  Use of double sequential external defibrillation for refractory ventricular fibrillation during out-of-hospital cardiac arrest.  Resuscitation 2016; 108:82-6.</ref>.
  
 
==Indications==
 
==Indications==
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==Contraindications==
 
==Contraindications==
 
* Spontaneous circulation
 
* Spontaneous circulation
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* Inability to apply two sets of defibrillation pads without overlapping
  
 
==Equipment Needed==
 
==Equipment Needed==
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==Procedure==
 
==Procedure==
 
# Apply second set of defibrillation pads (configurations vary)
 
# Apply second set of defibrillation pads (configurations vary)
# Charge both monitors to the desired energy level
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# Charge both monitors to maximum energy level (200J for biphasic, 360J for monophasic)
# After ensuring providers are not in contact with the patient, simultaneously activate the defibrillation/shock button on each monitor
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# After ensuring providers are not in contact with the patient, charge and simultaneously activate the defibrillation/shock button on each monitor
 
# Resume chest compressions
 
# Resume chest compressions
  
 
==Complications==
 
==Complications==
* Ineffective deliver of electrical defibrillation due to overlapping or improperly applied pads
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* Generally none
* Inability to apply two sets of defibrillation pads without overlapping
 
  
 
==See Also==
 
==See Also==

Revision as of 02:49, 31 December 2016

Overview

  • In patients suffering from non-traumatic cardiac arrest who exhibit ventricular fibrillation refractory to standard defibrillation, two simultaneous shocks may be considered. This is termed double sequential external defibrillation (DSED) and has been shown to have some effect in terminating VF[1][2], though existing data on neurologic outcomes conflict. Several large EMS systems currently use DSED in their standing medical orders[3].

Indications

Contraindications

  • Spontaneous circulation
  • Inability to apply two sets of defibrillation pads without overlapping

Equipment Needed

  • Two monitors capable of manual defibrillation (both biphasic or both monophasic)
  • Pre-hospital or hospital provider credentialed to perform defibrillation
  • Two sets of defibrillation pads

Procedure

  1. Apply second set of defibrillation pads (configurations vary)
  2. Charge both monitors to maximum energy level (200J for biphasic, 360J for monophasic)
  3. After ensuring providers are not in contact with the patient, charge and simultaneously activate the defibrillation/shock button on each monitor
  4. Resume chest compressions

Complications

  • Generally none

See Also

References

  1. Hoch DH, et al. Double sequential external shocks for refractory ventricular fibrillation. J Am Coll Cardiol. 1994; 23(5):1141-5.
  2. Cabanas JG, et al. Double Sequential External Defibrillation in Out-of-Hospital Refractory Ventricular Fibrillation: A Report of Ten Cases. Prehosp Emerg Care. 2015; 19(1):126-130.
  3. Cortez E et al. Use of double sequential external defibrillation for refractory ventricular fibrillation during out-of-hospital cardiac arrest. Resuscitation 2016; 108:82-6.