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how many times can a human be defibrillated?

CCU   (44,847 Views | 37 Replies)

TinyNurse is a RN and specializes in Emergency.

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I've only been an ER nurse for a year, so i haven't seen much, most i've seen someone shocked is 4 times............... but

have you ever had a patient on your unit, say in cardiogenic shock, goes into long runs of vtach, and needs to be shocked 7-8 times every 18 hours for 6 days?????

I've attempted to research "effects of repeated defibrillation" with no luck. I only know that each shock is like running a mile to the body.

Just wondering if any of you CCU nurses have seen this, and if you've seen survivors.

Thanks in advance

Jenni

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111 Posts; 2,967 Profile Views

You might ask some cath lab nurses. I have seen quite a few more than 4. With several survivers that still bring us cookies on their "special day".

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243 Posts; 4,899 Profile Views

I think the most I've ever shocked one patient was 8 or 9 times. He was a post cath stent to the RCA with reperfusion v-fib/v-tach. The first time he went into vfib it took 3 shocks to regain a rhythm. I used the biphasic defibrillators that only reach a 170j maximum. After that he had a few more episodes and eventually stopped (probably a combo of shocking and being loaded with amiodarone 3 times). We left the handsfree pads on him and shocked when needed. Interestingly enough, each subsequent shock needed less electricity (around 100j). He walked out of the unit 3 days later.

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75 Posts; 1,727 Profile Views

i have sustained patients in the er for 6 hours in order to let immediate family arrive (i.e. 40 y/o male out of town sustained v-tach; 35 y/o wife and 6 y/o and 8 y/o daughters). sad, sad, sad.

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hoolahan is a ASN, RN and specializes in Home Health.

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I worked in a CT ICU, and I am told in one day, a pt I got on nights, had been defibrillated 36 times. He died on my shift, the family joined in a circle around his bed and refused to allow any more resuscitation efforts to be made. He was paced when I came one, and when the BP started to fall, I called family first, then doc, resident called attending who wanted everything done, but finally had resident turn off the pacer and said he could only honor the DNR request if there was no cardiac activity under it, and there wasn't.

Other than that extreme case in aa fresh post-op CABG, another young CABG fresh post-op was defib'd 18 times. Seen a few in the teens, but usually only if they were in their 40's or low 50's in age. In the younger ones, it did "save" them, but as to thier QOL, I don't know. They were released in extremely debilitated conditions and had very poor exercise tolerance, so I believe they were more like cardiac cripples in the long run. After 1o years in the SICU there, I went to the MICU and saw how the "saves" turned out....made me leave critcak care eventually.

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1,245 Posts; 12,007 Profile Views

Well think about the fact that they are now placing internal defibrillators, obviously some people get shocked much more than others, I had one code where we shocked a guy 8 times because he would bounce back for a few minutes and while we were trying to get the gtt that was needed he would v-fib again.

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27 Posts; 1,836 Profile Views

There is no concrete number. After a number of defibrillations, however, your heart can undergo electroporation where the threshold power required to defibrillate will become much higher--and then you'll have some awfully stubborn VF/VT. I think this is really more applicable to ICDs which use internal defibrillating coils rather than external paddles (or patches)--but I suppose the same could hold true for external defibrillation. I've had ICD patients receive dozens of shocks in a few hours.

If the pt. had an ICD, it might be able to pace them out of the VT without getting shocked all the time. Maybe.

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462 Posts; 6,149 Profile Views

I work in a CTICU, and in some of our VAD patients, the heart becomes extremely irritable. There was one patient fresh from the OR with a HeartMate LVAD that we shocked over 200 (yes, two hundred!) times within 48 hours. She went into VF frequently, usually requiring 2 shocks to convert. She arrested so many times that they placed an RVAD three days after the LVAD was placed. Twelve hours after she came back from the OR with the RVAD, the heart transplant coordinator called...they found a donor for her transplant! She walked out of the hospital three weeks later. She still stops in from time to time to let us know how she is doing.

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32 Posts; 1,724 Profile Views

Cardiogenic shock is pump failure and Vfib is an electrical problem. The two may be related for some reason, but you have to ask yourself more questions if you shock the same heart constantly. Like why am I refractory? Why I am I not getting better? What am I failing to treat? Is this all simple irritability and will resolve on its own? Am I ischemic...hypovolemic....hypervolemic? As one person mentioned...is my demand too high and I my SVO2 just too low and I need LVAD, RVAD, ECMO?

There is no textbook answer...only reassessment...and intervention. Isn't it fun being forced to think and chew gum at the same time?:)

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155 Posts; 3,193 Profile Views

originally posted by heartICU: There was one patient fresh from the OR with a HeartMate LVAD that we shocked over 200 (yes, two hundred!) times within 48 hours

WOW! :eek: And I thought our BiVAD patient had a lot of shocks. 3-4 times every hour for about 12 hours.

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22 Posts; 1,605 Profile Views

I've only been an ER nurse for a year, so i haven't seen much, most i've seen someone shocked is 4 times............... but

have you ever had a patient on your unit, say in cardiogenic shock, goes into long runs of vtach, and needs to be shocked 7-8 times every 18 hours for 6 days?????

I've attempted to research "effects of repeated defibrillation" with no luck. I only know that each shock is like running a mile to the body.

Just wondering if any of you CCU nurses have seen this, and if you've seen survivors.

Thanks in advance

Jenni

I've been a cardiac cath nurse a long time and I think every case is different.

Whatever it takes as long as the patient is responding to your efforts in some way. Sometimes multiple shocks and drugs can get you through until you can finish a much needed intervention. I also think it is very important to know your patient's wishes whenever possible, although that is tough with the ED patients.

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TinyNurse is a RN and specializes in Emergency.

692 Posts; 8,687 Profile Views

Thank you for the many replies. This didn't happen to a patient in my ER, it happened to my dad 2 weeks ago. My father passed on July 19th. He was 48 years old. No cardiac history ( many risk factors, family hx, 2 pk/day smoker, obese) No medical history, no home meds.

2 caths, 2 stents, balloon pump, every drip you could name ( cardiologist told me "your father has more drugs going in him than any other patient in this hospital") put him on a vent so his heart could rest.........

he was not a candidate for lvad,or complete bypass d/t weight of 313, they wanted him to get. "stable" so that an internal defibrillator could be placed........... he just couldn't get stable.

I guess i've never seen anyone so sick, I mean my dad walked out to my car with cp rated as a" 4". I took him to an ER 2 minutes away from his home, small ER ( not the one I work in) cuz "time is muscle" right????

He ended up at OSU medical Center , where the staff was wonderful, my dad just couldn't be saved. I guess I'm just having a hard time with the sickest person I've seen being my own father. having a hard time with him walking out to my car, and me joking with him while he was stable and getting worked up, about possibly "getting a foley".

I love my dad! Thanks again so much for your insight into something that was really out of my control.

xo Jenni

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