Hands-On Defibrillation

This video is a shortened version of a longer video reviewing hands-on defibrillation and presenting simple solutions that protect the provider and would allow continuous CPR during manual chest compressions. Electrician's gloves seem to be a simple solution that allows continuous un-interrupted chest compressions with minimal risk to the provider.

[ATFDFF]

Love your content, Dr. Mellick! I just have one thing I might throw out there, particularly if using a mechanical CPR device with A/P pad placement. As we know, modern, biphasic monitors will calculate pad distance/impedance and adjust electrical output upwards and downwards slightly from the selected energy level. We discovered that given the depth and quality of LUCAS compressions, with some level of regularity our monitors were calculating the shorter pad distance during the downstroke and decreasing energy output…however obviously it’s not easily possible to ensure you’re delivering that defibrillation during the downstroke. So, as a result, we found we were often delivering lower energy defibrillations during the upstroke when pad distance is dramatically increased.

[MotoNurse]

I've been trying to push for this for a while along with pre-charging the defib but as a lowly RN I've been mostly ignored or put down for both. I've done it this way a few times to people's amazement (standing on a stool with rubber legs helps prevent grounding as well) but it's usually met with the physician or another nurse cussing me out. We need a lot more education in this aspect and a lot of changes in resuscitation methods. I feel we're still only at the top of the iceberg and there's so many areas for improvement (getting rid of large dose epi pushes, starting a sedation regimen due to conscious CPR, properly sized BVMs and faster vent connections, etc). Have you found that since demonstrating it and implementing it that staff were more receptive to it?

[theparaminuteman]

Been saying this for a while. Thanks doc!!!

[eddyballester]

what is “appropriate gear during defibrillation?” confirming, uninterrupted, manual CPR was being provided when defibrillation at 360 joules delivered?
Does it matter what type gloves worn? insulated gloves?

[arty]

Dont know what it is called...but the machine that is doing chest compressions is a badass. However i know bones can break in CPR....but my question is can these bones penetrate the lungs? And if so how do you know immediately?

[joefolsom]

Doc, how can you be sure of a shockable rhythm if you’re doing uninterrupted CPR? For example, I’ve seen what looks like V Tach during CPR (probably artifact from the chest compressions) that then shows asystole during pulse check.

[mptmatthew]

This is really interesting. What’s your opinion on removing oxygen (if there isn’t an ETT sited) during defibrillation? I think the risk is probably relatively minimal and theoretical, but we are still taught that the patient WILL catch fire if you leave any oxygen within 1m!!

Sometimes I’ve found it causes delay or confusion (e.g. some clinicians will shock with an LMA/IGEL, others insist it is disconnected from the oxygen adding an extra step/delay).

[MrSkogman]

And what exactly is appropiate protective gear?

[bhstone]

Person doing the chest compressions going WAY TOO FAST.

[atinypuffin]

That purple wrist band looks like a DNR band 😅 maybe its a fall band or something or his family revoked it.

[drwadda]

Interesting... what are the "appropriate protective gear" mentioned? Anything special?

[EmanO]

Why do you have your bare hand on someone being shocked? Are you implying that unintended shocks are not a real thing? Seems like you’d have a “do not try this” caption.

He even said he felt a small jolt. He might not being saying that if the shock was on his T wave or if it was someone with less body mass

I’m not sure this is a responsible video and probably even dangerous