Dr. Schepke explains double sequential defibrillation for ventricular fibrillation that won't stop. Two defibrillators create perpendicular shock vectors to cover more heart muscle. The technique applies when standard shocks and drugs have failed, with a step-by-step demo of pad placement and synchronized delivery.
Questions this video answers
Two doses: first 300 milligrams, second 150 milligrams.
Both charged to 360 (joules).
Anterior and posterior (posterior pad applied via log-roll).
LifePak 15.
The Lucas mechanical chest compression device (switched to manual compressions during pad placement).
Chapters
One of the new things you'll see in the protocol is double sequential defibrillation. I'm going to go over what that means and when we use that real quickly here. So if you've ever had a case where you had a patient was in ventricular defibrillation and you shocked them at the maximum joules and nothing happened, they stayed in V fiber. These are the cases we're talking about. Basically, the purpose of defibrillation is to put the heart into asystole with the hopes that the sinus node will then come back and take over the function of the heart. What happens in intractable ventricular fibrillation is you give the energy and it's not enough to shock the heart out of V fib, and the patient just stays in V fib. So normally what you'll see is you'll have V fib, you give the shock and then you have a period of asystole afterwards, even if it's only for a few seconds. That's not the case I'm talking about. The case we're talking about is you have V fib, you shock them, and immediately after the shock, it's still V fib. It never put them into asystole. One of the theories why this occurs is that as the energy goes through the heart, you're getting part of the heart, but not all of the heart shocked at the same time. So what we're going to do for these cases, what the studies are showing, that we can actually save some of these folks that up until now, universally, they all die. And is you use two defibrillators, and what you do is you put the pad in our usual standard location in the beginning. And then if it turns out that you need to use the second defibrillator, what you'll do is put the second pad's anterior and posterior. So now what you're doing is you've got the energy vectors going in two different directions. So the surface area of the heart that gets shocked is much larger, and you're much more likely to get the entire heart shocked and defibrillated at the same time. So you'll put both of the pads on two monitors, both at max setting, and you go three, two, one, and push, both pretty much as close to the same time as possible. And that will convert some of these folks and we'll be able to save some of their lives.
So I'm just going to echo what Dr. Schepke said real quick and tell you when we're going to perform this actual double sequential defibrillation. So this patient has been in cardiac arrest for quite a while now. Because we've maxed out on our antiarrhythmics, we've given two separate doses of amiodarone, the first being 300 milligrams, the second being 150 milligrams. We've standard defibrillated the patient probably four or five times by now. And then when we bring in the second monitor, we've confirmed on both monitors the patient has remained in V fib and is remaining in V fib. So bring in the second monitor, put on the second pair of pads, and we're going to go ahead and perform the procedure. So you'll see the Lucas is already running on the particular patient, and the crew's going to stop the Lucas machine and they're going to pull it off and start manual compressions while the person working the LifePak is going to hook up the additional lifepak and show you how this procedure goes. So the first thing is we're going to go ahead and power the second LifePak on, and then we're going to get a set of combo pads and we're going to go ahead and put them on the patient. Now, as you see, there's already a set of combo pads in the normal position. As we would usually be defibrillating the patient. These pads are actually going to go on the anterior and posterior section. So you'll see the chest compression person stop, resume chest compressions. And then we're going to log roll the patient using all three of our crew members and put the pad on the posterior portion of the patient. So they'll demonstrate that at this time.
And then when you see them put them back down, they're going to resume chest compressions. The goal is to minimize the hands off the chest time. So now you'll see that the person working the LifePak 15 is going to switch it over into paddles and confirm that both monitors reveal V fib. After that's done, the person working the monitors is going to go ahead and charge both of the monitors to the maximum setting.
So as you see, both defibrillators have charged up to 360. He's going to clear everybody and make sure they're clear, and. And then he's going to attempt to push the shock button simultaneously.
After that procedure is completed, we're going to immediately resume chest.
