Monday Morning in the ED.. 54 year-old male with palpitations and - - PowerPoint PPT Presentation

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11/4/2013 Monday Morning in the ED.. 54 year-old male with palpitations and chest pain AF with RVR, rate 155 bpm, BP 89/46 Shocking Revelations in Electrical Management of Dysrhythmias Eric Silman, MD Assistant Residency Director,

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Shocking Revelations in Electrical Management of Dysrhythmias

Eric Silman, MD Assistant Residency Director, UCLA/Olive-View EM Residency Ronald Reagan-UCLA Medical Center

Monday Morning in the ED…..

54 year-old male with palpitations and chest pain AF with RVR, rate 155 bpm, BP 89/46

Objectives

Pad Placement Monophasic vs. Biphasic Hands-On Defibrillation Energy

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Monophasic Biphasic Monophasic Biphasic

Technology Energy New Lower More Shocks Myocardial Injury Less Old Higher Fewer More

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Pad Placement

Anterolateral Anteroposterior

Energy

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Atrial Fibrillation Energy 200 J 200 J Ventricular Fibrillation Double Down! You cardiovert your patient…

Biphasic defibrillator, 200 Joules synchronized

Your tech starts CPR…

Pads placed antero-posteriorly

Hands-On Defibrillation

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Hands-On Defibrillation

Worth It? Rationale Evidence

Summary

Pad Placement Monophasic vs. Biphasic Hands-On Defibrillation Energy

200 J* Biphasic! Any (VF), Anteroposterior (AF) Maybe not

Thank You esilman@mednet.ucla.edu References

Botto GL, et. al. External cardioversion of atrial fibrillation: role of paddle position on technical efficacy and energy requirements. Heart. 1999, 82: 726-30. Freeman K, et. al. Biphasic defibrillation does not improve outcomes compared to monophasic defibrillation in out-of-hospital cardiac arrest. Prehosp Emerg Care. 12 (2):152-6. Link M, et al. Part 6: electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular

Care. Circulation. 122; (18 suppl 3):706-19.

Christenson J et al. Chest compression fraction determines survival in patients with outofhospital ventricular fibrillation. Circulation. 2009 Sep 29; 120(13):1241- 7. Lloyd M et. al. Hands-on defibrillation: an analysis of electrical current flow through rescuers in direct contact with patients during biphasic external defibrillation.

Circulation. 2008 May 13;117(19):2510-4.