Jump to content

Pulseless patients: shock or drugs

When coding a pulseless patient in VT or VF do you generally shock them first or use drugs in your practice?

When coding a pulseless patient in VT or VF do you generally shock them first or use drugs in your practice?

Shock!!!!!!!!!!!!!!!!!

Shock times three...then drug-shock-drug-shock! Always use electricity first!

gwenith, BSN, RN

Specializes in ICU.

Shock!!!! Always shock first. The evidence is unassailable and is the main reason for autmatic defibrillators.

tridil2000, MSN, RN

Has 33 years experience.

When coding a pulseless patient in VT or VF do you generally shock them first or use drugs in your practice?

no pulse with vf or vt?

shock 200

why do you ask?

vt or vt "shock, shock, shock, every body shock shock shock and lets make patients better"...............!:rolleyes:

when coding a pulseless patient in vt or vf do you generally shock them first or use drugs in your practice?

The reason I ask is because I saw a relatively healthy person suffering acute illness shocked after going into pulseless VT at around 160 bpm. The initial shock converted him into VF than asystole. He died after continued resusitation attemps.

When coding a pulseless patient in VT or VF do you generally shock them first or use drugs in your practice?

LOL. Aren't you the one who thought you should be able to step onto an ambulance right after nursing school? Good luck with that.

I am sorry that you misunderstood the subject matter discussed in this post. I am also sorry that you misunderstood an earlier post of mine. Maybe you can try to interperet again,

"I agree with Biffs25, there is no reason that an RN shouldn't be allowed to gain prehospital certification quickly and economically especially after taking ACLS."

Hope that helps.

LOL. Aren't you the one who thought you should be able to step onto an ambulance right after nursing school? Good luck with that.

Dixielee, BSN, RN

Specializes in ER. Has 38 years experience.

Eric, I think all the literature supports the shock, shock, shock theory. The person you saw may have just been circling the drain anyway, and nothing was going to help. There are exceptions to every rule, you just have to go with the odds. I have rarely seen anyone come "back" after CPR, but have seen quite a few after potentially fatal arrhythmias.

Yes, you're right that it was more than likely inevitable and this was only one case. Having only witnessed a handful of codes with only one turnaround I see where you are coming from. I still find myself questioning whether or not this is an appropriate first line intervention.

Eric, I think all the literature supports the shock, shock, shock theory. The person you saw may have just been circling the drain anyway, and nothing was going to help. There are exceptions to every rule, you just have to go with the odds. I have rarely seen anyone come "back" after CPR, but have seen quite a few after potentially fatal arrhythmias.

I have seen many unsuccessful rescitations with healthy persons who have suffered a lethal arrythmia. The studies have showed that without shock there is little to no chance of survival.

The reason I ask is because I saw a relatively healthy person suffering acute illness shocked after going into pulseless VT at around 160 bpm. The initial shock converted him into VF than asystole. He died after continued resusitation attemps.

Not only would you shock them three times, but if the rhythm is still the same and meds arent readily avail (say, in the field), you could shock them a 4th. (Dont forget, only 10% of all arrests survive....) You're relatively healthy person probably had a blockage of his Widow Maker, and little or no collateral development.

Its mos def more than appropriate to defib as the first, second and third lines of tx in vfib/pulseless vt. You can read all the studies if you'd like. There were thousands and thousands of studies done here and in Europe. You probably could have given him 10 rounds of drugs, to no avail. Dont forget, we are an EBP (evidence based practice).

Yes, you're right that it was more than likely inevitable and this was only one case. Having only witnessed a handful of codes with only one turnaround I see where you are coming from. I still find myself questioning whether or not this is an appropriate first line intervention.

Eric, I think all the literature supports the shock, shock, shock theory. The person you saw may have just been circling the drain anyway, and nothing was going to help. There are exceptions to every rule, you just have to go with the odds. I have rarely seen anyone come "back" after CPR, but have seen quite a few after potentially fatal arrhythmias.

Well by now you have got an answer - and a rather shocking one at that. - Think practical terms - wham bam - shock away - the electrical disosciation verses a potential chemical value of a bolus push is pretty clear (the heart works by an electrical wave impacting on muscle - with a shcok we are essentially saying start pumping again damn it.... with chemical swamping we are trying to help that electrical wave (something to try after a first, second or even third attempt at electrical jump starting (ie a shock). Or if you are more mechanically minded - when a cars battery goes we use jumper cables before we replace the battery fluid. (hey its a far stretch put the principle is similar)

cheers

Peter

Well its unanimous, if thats what the American public wants than a quick shock to the heart is what they'll get :)

tridil2000, MSN, RN

Has 33 years experience.

Well its unanimous, if thats what the American public wants than a quick shock to the heart is what they'll get :)

for v fib or pulseless v tach

yes.

According to the American Heart Association in 2004 Some research suggests that there may be special resuscitation situations in which rescuers should administer medications, particularly adrenergic agents, before defibrillation. In the deterioration of VF to asystole there comes a point at which the shock is very likely to produce postshock asystole. Under these conditions the patient might be better served if medications were administered before defibrillation.

"In the deterioration of VF to asystole there comes a point at which the shock is very likely to produce postshock asystole. Under these conditions the patient might be better served if medications were administered before defibrillation."

Exactly, If you have VF deteriorating to asystole you would want to begin your ABC's and administer vasoactives and not shock (since in asystole, there is nothing to shock). As stated before, the ACLS protocol (Developed using Evidence Based Practice) states for Pulseless VT or VF to deliver 3 stacked shocks (the goal being to reset the electrical impulses being generated to something more organized then VT/VF), Assessing the rhythm between each shock, Assessing for a pulse after your stacked shocks and if no pulse to resume compressions and then move on to meds...

Guest
This topic is now closed to further replies.
×

By using the site you agree to our Privacy, Cookies, and Terms of Service Policies.

OK