ACLS review

221.  What are the initial and subsequent joule settings when defibrillating a patient with a monophasic defibrillator?

If you are using a monophasic defibrillator, give an initial single 360-J shock and use the same energy setting for subsequent shocks.

222.  In order to maintain rescuer safety, should CPR be interrupted while the defibrillator is charging?

No.  Continue CPR while the defibrillator is charging and continue until told to “clear” the patient.  Even a 5-10 second pause in chest compressions reduces the chance that a shock will terminate VF/VT to a profusing heart rhythm.

223.  Biphasic defibrillators are effective at terminating VT over a variety of joule settings.  If you do not know the manufacturer’s effective biphasic dose setting, what joule setting should you use?

If you do not know the manufacturer’s effective biphasic dose setting then deliver 200 J for the first shock and an equal or higher joule setting for subsequent shocks.

224.  What should you do if VF is terminated by a shock but later recurs in the resuscitation attempt?

If VF recurs later in the resuscitation attempt then deliver subsequent shocks at the previous successful energy level.

225.  After delivering a first shock at 200 J, you note that the patient remains in refractory VF.  What should you do next?

Immediately after the first shock, resume CPR, beginning with chest compressions.  Give 2 minutes of CPR (about 5 cycles).  In the patient without an advanced airway, a cycle of CPR consists of 30 compressions followed by 2 ventilations.


Reviewed 2/28/16