Number of shocks

EMT-2-RN · Jan 16, 2008

I have not seen someone manually shocked that many times but have encountered a patient who kept going into V tach every few minutes or so and his internal defib went off at least 15 to 20 times before we got him on a lidocaine gtt.

getoverit, BSN, RN, EMT-P · Jan 16, 2008

They really manually defibrillated him 20 times? that's a lot. do you know if it was biphasic or not? were they defibs or cardioversions? internal vs. external shocks?

I've worked a lot of codes and the most I've ever shocked someone was probably 10-12. but if he needed it, nothing beats electricity.

Blee O'Myacin, BSN, RN · Jan 16, 2008

My aunt's neighbor was having some kind of vascular surgery and ended up having 2 heart attacks. Don't know all the details, but they ended up shocking him 20 times! He ended up dying a week or two later. Just wondering if someone has heard of anyone getting shocked that many times?

So your aunt's neighbor's family member tells you about a surgery and subsequent "shocks", could be like a game of "whisper down the lane" - where the message gets completely distorted at the end.

But, a shockable rhythm is a shockable rhythm. So if he kept going into sustained pulseless v-tach or v-fib and the shocks were bringing him back into sinus... I'd guess that he was most likely externally paced - less joules than a defib shock, but delivered every few seconds to keep the heart beating. Then, as soon as possible, a pacer wire is inserted. (At least that's what I've seen).

In a "regular" code, there is PEA or asystole far more often than v-fib or pulseless v-tach. While coding, we are also treating underlying causes if possible.

Blee

glasgow3 · Jan 16, 2008

So your aunt's neighbor's family member tells you about a surgery and subsequent "shocks", could be like a game of "whisper down the lane" - where the message gets completely distorted at the end.
But, a shockable rhythm is a shockable rhythm. So if he kept going into sustained pulseless v-tach or v-fib and the shocks were bringing him back into sinus... I'd guess that he was most likely externally paced - less joules than a defib shock, but delivered every few seconds to keep the heart beating. Then, as soon as possible, a pacer wire is inserted. (At least that's what I've seen).
In a "regular" code, there is PEA or asystole far more often than v-fib or pulseless v-tach. While coding, we are also treating underlying causes if possible.
Blee

Sure, I've shocked patients that often...and it needn't be pulseless v-tach or fib. Just refractory to medication drips/rebolus and still going into sustained v-tach.

rnwithtof · Jan 16, 2008

I was at my aunt's house at the timek, but I don't know all the details. It was all happening the weekend my cousin was graduating from nursing school.

**canoehead, BSN, RN** · Jan 16, 2008

At a hospital in Canada an ICU patient kept going into v-tach, the nurses kept shocking him and getting him back. The doc refused to come in or order different meds. It was a conflict over who was covering the patient (not it!). That man got shocked over a hundred times that night, and lived.

gradcare, LPN · Jan 16, 2008

Had 1 guy single shock eveery 2-3 min for recurrent VF. Now has internal defib. I can recall at least 20 till end of shift, took a while to get him chemically to the point where he no longer needed electricity. Think he's doin ok now though

Diana,RN · Jan 16, 2008

Kind of off topic but I just have to share:

Had a 80-something female patient, huge abd. surgery in dec, intubated for over a week (difficulty weaning her off), transferred from ICU to med-surg. I'm providing pm care and suddenly my pt. goes into resp. arrest. Called a code and 20 min late she is back and alert (w/o tube and shock, just bagged and cpr). ICU transfer follows. This was "my" first code (my own pt that is). I was soo scared but my training took right over and things just happened on auto-pilot.

Now I am tired and very glad to have this night off.

Good night everyone,

(a kinda proud) Diana

Blee O'Myacin, BSN, RN · Jan 16, 2008

Sure, I've shocked patients that often...and it needn't be pulseless v-tach or fib. Just refractory to medication drips/rebolus and still going into sustained v-tach.

Thanks for the info. We've externally paced people who fit your described scenario. Are you using the full 150J biphasic? Is it because the synced pacing doesn't work for this patient or are you trying to get them to respond to meds alone, and you don't want to deliver the shocks at regular intervals? I'm curious as to why one way and not another since this scenario does not come up often.

Thanks again,

Blee