how many times can a human be defibrillated?

eprn · Aug 14, 2004

Regarding the surgeon who was annoyed that his patient was shocked so many times: If they're in VF, they need a shock. Period. Electricity is really the only thing that fixes VF, so the surgeon's choice is simple: living patient vs. dead patient.

Yes, defibrillation damages the heart. You can see cardiac enzymes elevate after someone's been shocked, and it can make pacing thresholds go up significantly. But...it beats death.:chuckle

Ruby Vee, BSN · Aug 15, 2004

I've seen patients shocked 6 or 8 times every few hours for DAYS! There was one patient I shocked 128 times on my shift. Surprising how much the human body can take!

KR · Oct 27, 2004

Hiya. I personally defib'd the same patient 14 times. He went into VT at another, smaller hospital, and they defib'd him there. Then they flew him to us, and the flight crew had to defib him in route, and also before I got him on my monitor. I gave him massive amounts of Amiodarone. Patient went home with minor memory problems, otherwise just fine from what I heard.

KR · Oct 27, 2004

Hiya. I personally defib'd the same patient 14 times. He went into VT at another, smaller hospital, and they defib'd him there. Then they flew him to us, and the flight crew had to defib him in route, and also before I got him on my monitor. I gave him massive amounts of Amiodarone. Patient went home with minor memory problems, otherwise just fine from what I heard.

begalli · Oct 27, 2004

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.

Gosh, don't you love these kind of outcomes.

We had a guy who was on a BIVAD (Thoratec) for months. He endured so much. Every organ in his body failed at one time or another, and both of his feet and all of his fingers were purple-blue. He was just one of those patients where you just shake your head and say poor guy. We did however get him well enough to finally accept a donor heart.

One of the nurses I work with said she saw him on her way into work the other night. He was sitting outside with his family. He called out to her right away, but it took her a minute to recognize this new man!

We get the sickest of the sick. I can think of several stories just like this one and the one you describe, hearticu, but I can think of many many more that aren't so fortunate. The ones that overcome what seem to be incredible odds, are the ones who motivate me to keep going when it really doesn't look like there's much left to do.

It's pretty amazing.

I've never really counted, but I agree that patients with VADs sometime require many shocks for many days/weeks.

begalli · Oct 27, 2004

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.

Gosh, don't you love these kind of outcomes.

We had a guy who was on a BIVAD (Thoratec) for months. He endured so much. Every organ in his body failed at one time or another, and both of his feet and all of his fingers were purple-blue. He was just one of those patients where you just shake your head and say poor guy. We did however get him well enough to finally accept a donor heart.

One of the nurses I work with said she saw him on her way into work the other night. He was sitting outside with his family. He called out to her right away, but it took her a minute to recognize this new man!

We get the sickest of the sick. I can think of several stories just like this one and the one you describe, hearticu, but I can think of many many more that aren't so fortunate. The ones that overcome what seem to be incredible odds, are the ones who motivate me to keep going when it really doesn't look like there's much left to do.

It's pretty amazing.

I've never really counted, but I agree that patients with VADs sometime require many shocks for many days/weeks.

begalli · Oct 27, 2004

What is gtt, I only know it as glucose tolerance test.I gather it has to do with drug doses?

We also use it to refer to an IV drug infusion. I use it sometimes when writing verbal orders (pharmacy doesn't complain, but I'm sure it probably shouldn't be used that way).

eg: epi IV gtt 0-100 ng/kg/min for map of 60 or greater.

begalli · Oct 27, 2004

What is gtt, I only know it as glucose tolerance test.I gather it has to do with drug doses?

We also use it to refer to an IV drug infusion. I use it sometimes when writing verbal orders (pharmacy doesn't complain, but I'm sure it probably shouldn't be used that way).

eg: epi IV gtt 0-100 ng/kg/min for map of 60 or greater.

CCURN · Dec 29, 2004

We were talking about this at work, and somebody said that they shocked somone 40 times during a code, but I am not sure of the outcome......

medic1488 · Jan 8, 2005

Personally, 16 defib, but guy expired anyway so I guess that doesnt count. A friend of mine encountered a patient in the field, defib * 2, both with return of perfusing rythmns, despite multiple attempts at antidysrythmics the patient would degenerate into v-fib every 2-3 minutes. Multiple shocks in the ED before he was transferred to a cardiac cath lab, helicopter wasnt flying, so a 45 minute ride with lights/siren/ and a clear road. The same medic took the transfer. With a lifepack 12 and a set of quick combo pads he defibbed (all at 200J) 76 times en route. We learned that the monitors internal memory stopped recording at around 54 defibs and a complete roll of paper would only print out about 35-40. The patient then received multiple more defibs at the receiving hospital, until his problem was ultimately corrected. I heard in total upwards of 300 defibs throughout event, survived to be discharged home several days later. Although I cant gurantee that the 300 number was true, I saw the code summary and printout and can verify at least 78 of them, all with conversion. And I'm sure some of you are doing the math and saying that 2-3 mintues apart with a 45 minute drive would only be 15-22 shocks or so, but dont forget to add all the additional time loading, transporting, loading into hospital and getting onto receiving hospitals equipment.

cabgrn2 · Jan 12, 2005

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

We had a post open patient with multiple dysrhythmias including numerous runs of VT. I believe he was shoked about 40 times during his stay before they decided he was doing well enough otherwise to warrant an automatic defibrilator. In one 24 hour period I think the nurse's count was 23 times. He walked out of the hospital. He was only in his 40's and had good cardiac function (per echo).

bobnurse · Jan 18, 2005

I remember in 1992 when you defib asystole....We shocked this guy probably over 70 times over a 2 hour period. We called other floors to see if someone needed to check off on defib or if anyone hadnt done cpr before.........