I'm a new grad who has been on a step-down floor for a few months now, and I'm getting ready to take ACLS. I've come across something I'm totally not familiar with, and I'm freaking out because I feel like I ought to know what it is. There are several questions about "ventricular fibrillation that has been refractory to an initial shock" or "to a second shock." What on earth does that mean? V-fib can be induced by a defibrillation during the refractory period, right? Is that what they mean--that a doctor or nurse used a defibrillator and it shocked (once or twice, for "initial" or "second") the patient and sent them into v-fib? I'm not trying to get someone to give me the answers--the questions are actually about pharmacology--but I am panicking that I'm not going to have any idea what they're talking about in class. Yikes!
Oct 29, '12
Refractory to means not fixed by in that context. So if shocking your v-fib isn't working, what other intervention might you want to try? You're on the right track when you mention that it's a pharmacology question.
Oct 29, '12
Oh, now it makes so much more sense! I have never heard anyone say "refractory to" when they mean "wasn't fixed by"--that's really odd. Thank you so much for clearing that up!!
Oct 29, '12
It means that the v- fib is being stubborn and has not converted with the shocks. It does not mean that the pt was thrown into v-fib by a defib. Another example would be continued SVT refractory to 6 mg of adenocard. Refractory, in this case, means resistant to treatment. Hope that helps.
Nov 8, '12
What pharmacology agent would you give to make the V Fib more convertable/coarse
Nov 12, '12
If you are ever bored and want an interesting read search for some articles on "Double Sequential Extermal Defibriillation" or DSED. Pretty interesting concept of using two defibrillators for refractory VF.
Dec 9, '13
Good question and if you are really interested in learning more about the treatment of VF & pulseless VT, you'll find that there is NO evidence of any drug, improving survival to walking out of the hospital neurologically intact.
Also, remember that any antiarrhythmic can also be proarrhythmic.
Also note that while there is some evidence of short term increase of ROSC in VF/VT patients with Amiodarone, there was no increase in those patients walking out of the hospital neurologically intact.
The only treatments known at this time, that improve ROSC and walking out of the hospital neurologically intact, are high quality, uninterrupted CPR and defibrillation.
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