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Old 04-22-2009, 05:27 PM   #1
HatchetHarry
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Joules for Cardioversion and Defibrillation


Sup guys im studying for my 2nd cardiac test right now and I keep reading conflicting things about the required amount of joules. Part of this confusion comes from there being both biphasic and monophasic monitors. Ive tried googling but I find different answers.

Are monophasic monitors the only ones that go up to 360 J?

The Lifepak monitors that are the standard at fire depts these days are they monophasic or biphasic?

how many J do u cardiovert at?
defibrillate?

thanks


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Old 04-22-2009, 10:44 PM   #2
redcrossemt
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MONOPHASIC
Defibrillation is 360 J
Cardioversion for atrial rhythms is 50-100-200-300-360 J
Cardioversion for v-tach is 100-200-300-360 J

BIPHASIC (use device-specific energies when known)
Defibrillation is 200 J
Cardioversion for atrial rhythms is 30-50-75-120 J
Cardioversion for v-tach is 75-120-150-200 J

PEDIATRIC
First shock defibrillation, use 2 J/kg
Additional defibrillation attempts are at 4 J/kg
Pediatric cardioversion gets 0.5-1 J/kg first shock
Additional cardioversion shocks are at 2 J/kg.

I can find no reference to biphasic v. monophasic in PALS (or at least the quick reference card in the truck). Does anyone use device specific pediatric energies, or have a specific protocol to monophasic v. biphasic defibrillators for pediatric patients?
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Old 04-22-2009, 10:56 PM   #3
redcrossemt
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Quote:
Originally Posted by HatchetHarry View Post
The Lifepak monitors that are the standard at fire depts these days are they monophasic or biphasic?
LifePak 12's are available in both flavors. I believe at some point they went to all biphasic production, but there are still lots of monophasic monitors in service today.

Quote:
Originally Posted by HatchetHarry View Post
Are monophasic monitors the only ones that go up to 360 J?
Negatory, ghost rider. Depends on the monitor. Our LifePak Biphasics go to 360 J. Our Zoll Biphasics only go to 200 J.

Bottom line, you will need to know what your service uses and what the energy levels are for that specific device in your protocols. For testing, you should be able to ask the proctor before you begin as to what energy levels are recommended for the device you are using. Most proctors shouldn't have an issue as long as you know either all of the monophasic or all of the biphasic energy recommendations.
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Old 05-08-2009, 05:53 PM   #4
omak42
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so what you have been told so far is true....however the biphasics going up to 360 J is a little deceiving.....

heres how it works. biphasic machines will measure the impedence between the two pads and shock accordingly despite what you have the energy set at. however it will not shock with MORE than what you set it as. so if the machine detects it needs to shock at 120 J based on the impedence and you have your machine set at 100 J, it will shock at 100 J. but if you have your machine set at 150 J and it detects the impedence and decides to shock at 120 J, it will shock at the 120 J. In talking to training officers that I know the highest anyone has ever seen it actually deliver a shock at was 143 J....pretty interesting.

Does that make sense?
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Old 05-08-2009, 06:02 PM   #5
redcrossemt
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Quote:
Originally Posted by omak42 View Post
so what you have been told so far is true....however the biphasics going up to 360 J is a little deceiving.....

heres how it works. biphasic machines will measure the impedence between the two pads and shock accordingly despite what you have the energy set at. however it will not shock with MORE than what you set it as. so if the machine detects it needs to shock at 120 J based on the impedence and you have your machine set at 100 J, it will shock at 100 J. but if you have your machine set at 150 J and it detects the impedence and decides to shock at 120 J, it will shock at the 120 J. In talking to training officers that I know the highest anyone has ever seen it actually deliver a shock at was 143 J....pretty interesting.

Does that make sense?
I don't believe that what you're saying is true for all defibrillators. I know it is true for Zoll, however.

Medtronic Lifepaks (Adaptiv Biphasic Technology) actually deliver true dosing - at up to 360 joules biphasic power. They do measure impedance, but adjust to deliver the correct amount of power by changing the voltage. Adaptiv also can change the shock duration, but again, it preserves the power output.
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Old 05-08-2009, 06:04 PM   #6
omak42
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I was pretty sure that it was at least true for Medtronic Lifepaks also....Ive been trying to research it a little bit more though and cant seem to find anything yet
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Old 05-08-2009, 06:09 PM   #7
redcrossemt
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http://www.biphasic.com/reference/adaptiv_summary.pdf

There's better technical documentation elsewhere, and a few papers published, but I can't find them right now. The above is a good summary of how Medtronic developed their protocols. They automatically vary duration and voltage, and vary power by user selection or ramping AED protocols, to try and achieve the best response in each patient.
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Old 05-08-2009, 06:11 PM   #8
omak42
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haha good timing...i just found that article myself
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Old 05-08-2009, 06:13 PM   #9
redcrossemt
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*ping*
Does anyone use device specific pediatric energies, or have a specific protocol to monophasic v. biphasic defibrillators for pediatric patients?
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Old 05-08-2009, 06:23 PM   #10
omak42
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we do not have any device specific energy settings in our county. the only thing we have is 2J/kg for inital and 4J/kg for subsequent shocks.....nothing states any difference between mono or biphasic machines
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