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MSM Podcast Episode 7- Dual Sequential Defibrillation

We’ve mentioned plenty of time on this podcast that we have no real idea what we’re doing for cardiac arrest patients. The guidelines we work are not always consistent with the science. There’s a lot of interventions we perform simply because “that’s what we’ve always done.” But the fact remains, that the interventions that save people tend to be BLS interventions. Early, high quality CPR, and early defibrillation tend to be the difference makers.

So what happens when we introduce ALS interventions that don’t work either? We perform intubations, administer medications that are supported by questionable science, and we see no increase in outcomes. So what can we do differently? Enter Dual Sequential Defibrillation (DSD) or double sequential external defibrillation (DSED).

These interventions are appropriate for refractory VF patients that do not show a rhythm conversion after numerous defibrillation attempts. The initial physiology data for DSD dates back to 1994, although the technique wasn’t picked up by ALS providers until around 2014. The technique rests on applying a second set of defibrillation pads attached to a second monitor and delivering defibrillations almost simultaneously.

The goal is not to give both shocks exactly at the same time. The goal is not to give 720 joules of electricity. The goal is to offer and alternative, post-ACLS remedy to a cohort of patients that have a potentially survivable arrhythmia.

Paper of the Week

Comparing the success rates of standard and modified Valsalva maneuvers to terminate PSVT: A randomized controlled trial 

Corbacioglu (sic) et al. Am. J. Emerg. Med. May 2017

Related: REVERT Trial

MedBox

If you are working in EMS, or EM, and are not attending conferences, you’re missing out! The best, most cutting edge information is presented at conferences, not in classrooms. Here’s some that are worth attending.

Gathering of Eagles

CCTMC Where I met Bill Hinckley, who taught me the value of RSI.

SMACC