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dbbeal
09-23-2006, 08:52 AM
We have all heard of the horror stories of health professionals getting a shock while defibing a patient from my own experience I was performing a jaw thrust on a patient while my partner defibed the patient and I got nothing!!!! Are we paranoid. Given electricity takes the path of least resistance, we make very good resistors.
I have watched videos of people getting Tasered in training sessions supported by fellow workers. They do not seem to get a shock!!!!!

Thoughts please
I would love to hear from others who have had “first hand” experiences with touching patients while being defibed. did you actuly get a shock or just a fright.

RyanEMVFD
09-23-2006, 09:38 AM
Can't say that I have tried this. I've heard of some getting shocked but never witnessed it. Granted I'm not going to try it on purpose either.

doughesson
09-23-2006, 10:40 AM
Given that performing defibrillation on a patient isn't the same as using a Taser or other electric stun device to take a suspect into custody,I do not think we should try an AED on someone who has no problems.And in my brief experience,I have never heard of people getting shocked while touching a patient hooked up to the AED.On my old volunteer department,we always made sure nobody was touching the patient before pushing the shock button.
Wasn't it a year or so back,an EMT in New Hampshire or somewhere up North had her partner talk her into letting him put the pads on her for a shock and died?
If someone can find a perfectly good aircraft,I'll jump out of it before I volunteer for something like that.

needlejockey
09-23-2006, 10:42 AM
Let me put it this way, I ain't gonna risk it. Electricity scares me. I'm not gonna play around with it or risk it. In the off chance that all our previous safety training was for nothing.....

nmfire
09-23-2006, 11:41 AM
In THEORY, the electricity is looking for the path of least resistance from one pad to the other. By no meere cooincidenc, that happens to be right across your thorasic cavity which contains the heart we are aiming for.

In order for you to feel a significant shock, the majority of the electricity would have to go elsewhere through the body and take the long route up one of your arms and back out the other or something similar.

This whole process is VERY different from a traumatic electric shock from contacting power lines, electrical outlets, etc. In those instances, the electricity is flowing into you through one appendage and then out to the ground through whatever part of your body is on the ground or touching something conductive that is on the ground.

croaker260
09-23-2006, 07:42 PM
I am sure it also depends on WHERE you are touching the patient when you get the shock..for example, if you are doing compressions.....you might have a different outcome.
Also remember that many of the horror stories are left over from the era of monophasic defibrilation and shocks up to 400 J or greater.
Also from the era of gell and paddles (the jell can get all over the place), and before that, saline soaked gauze pads.

So, getting shocked MAY not be the risk it used to be, but it is still a potential (if uncommon) fatal incident. In addition, it is a severe loss of cool points if you shock your partner. On the otherhand...if you shock a firefighter or a supervisor.......

mitllesmertz1
09-23-2006, 10:28 PM
Shocked accidentaly twice, once in ED, once in field.
Barely felt it.
Maybe made me a little less intelligent, but you all knew that.

AZCEP43
09-24-2006, 02:47 PM
Risk is real, if somewhat less than some would like us to believe.

As a rule, don't hold the paddles on either side of your head, while charged, in the rain.

You should be fine.

REMSCHIEF
09-25-2006, 12:35 PM
As a rule...Always Clear your pt. Prior to Defib. It just makes sense.

Back in the day (LifePack 5 era...etc) the defib units did not have the best ground, so a shock was NOT uncommon if you were touching the pt. According to the sales reps "now the units are very well grounded, so even if you touch the pt. at the time of defib, you shouldn't get shocked" (sounds like the guy I bought a used car from...???)

I have to tell you...I would be the one to prove that theory wrong ("Sorry Mrs. Chief...our engineers told us that it wouldn't hurt anyone...")

Bottom Line: Think Safe!!! Clear your patient prior to Shock! (It is STILL a critical Fail on NREMT Skills!)


As for internal defib units...those do "tickle"...kinda feels like sticking your finger in a light socket...Don't ask.... :D


Stay safe...

Andy

bf1511
09-25-2006, 01:46 PM
As someone who has been shocked ( lifepac 10c) it is not fun. Mostly scared the crap out of me but nothing major. While intubating my overzealous partner decided it was time to shock and lit the world up. :eek: Pads not applied properly and all the other no no's. I felt tingling in my hands and the hair on my head stood up. It took a while but I finally got over my fear of the words shocking and clear. :eek: Brian

JimMccarthy
09-25-2006, 01:58 PM
Back a million years ago, I was working a code in the hospital.
The doc had just intubated the patient and I was standing at the head of the bed about two feet from the wall. I was breating the patient with one of those old, very conductive, black anesthesia bags (looked like a sausage narro at the end and wide in the middle). The ER intern (we called him Dr Destructo) came dashing in to save the day. Without looking, yelling clear or anything he proceded to gel up the paddles and hit the patient with 400J monophasic. I was looking at the vent to make sure the RT was getting it going properly when I found myself against the wall.
My friends said I looked like a cartoon character, slammed against the wall and sliding down to the floor.
I don't think I became unconscious, but, I don't remember a whole helluva lot.
Last I heard, the intern was graduating from a Proctology fellowship from a well known hospital and vet clinic in Bulgaria, at least I thought I heard thst!

Keep Safe, Y'all!

Jimmy

ghent11047
09-26-2006, 01:43 PM
I've used bvms on pts while they were being defibrillated on several occasions. I never felt a thing, those are the new ones not the anesthesia bags.

I have heard stories of people being shocked while being in contact with the stretcher.

Bones42
09-26-2006, 02:00 PM
dbbeal
Forum Member


Join Date: Sep 2006
Posts: 1

Looking at his profile....did he/she try this and not be able to make a second post? :eek: :p


I've used bvms on pts while they were being defibrillated on several occasions. The material a BVM is made from is not a good conductor of electricity.

Firescueguy
09-26-2006, 06:05 PM
And the reason for holding a jaw thrust on a pt. being defibrillated IS???? :confused: :confused:

If the patient is in arrest displaying a shockable rhythm (or if the AED is saying in a loud tone of voice CHARGING...STAND CLEAR), then maybe it might be in the best interest of the pt. as well as yourself and your crew to actually STAND CLEAR while they are being defibrillated!!! Defibrillation is THE definitive treatment for V-FIB/V-TACH according to ACLS...worrying about "bagging" (ventilating with a BVM), getting a line or loading the pt. take a backseat...quite simply, there is NO valid reason IMO for you to be holding open an airway or "bagging" while someone else is administering a shock other than trying to look cool like Roy & Johnny....which they never did BTW...even they cleared the pt.

While there are those cases where someone gets a little zap when they somehow contact the pt. (possibly through a puddle of urine...happened to a medic I know), you should not be trying a science experiment to see if you can tolerate electric shocks. If you want to bust a myth, then call the Myth Busters on TLC...do not endanger yourself, your crew and the pt. (remember him/her, the one who needs your help in their most urgent time of need??!!) by trying to be cool and show how macho you are.

Judging by your post, it sounds as though you do not fully understand the concept of defibrillation and its' impact on pt. care. I suggest you stop trying to show how strong/tough you are, partner up with a good ALS provider who can explain to you the concept of advanced/basic cardiac life support and start appplying those principles to the pts. you are there to treat. If you choose not, then perhaps you should apply for a role in the movie "Jackass 3"...

Just my 2 cents...Stay Safe...and remember, the best tool you can use in pt. treatment is COMMON SENSE...

needlejockey
09-26-2006, 06:57 PM
If you want to bust a myth, then call the Myth Busters on TLC...

I think their on Discovery.

doughesson
09-27-2006, 11:18 AM
I've used bvms on pts while they were being defibrillated on several occasions. I never felt a thing, those are the new ones not the anesthesia bags.

I have heard stories of people being shocked while being in contact with the stretcher.


About ten years ago,I was running a grocery boat on the Lower Mississippi when we got called back to the dock to carry an ambulance crew to a boat for a heart attack.
We get the Captain loaded and are running full out to the dock and the EMT and Paramedic are doing CPR.
At the time,I didn't know that defibrillators weren't required for all heart attacks so I offered the rubber pad from the wheelhouse for insulation if they needed it.
They declined,explaining the couldn't use the AED even on rubber pads due to the shock risk.
Unfortunately this story didn't have a favorable outcome but having recently been through EMT-IV schooling,I understand better what they were doing and why.

dbbeal
09-28-2006, 08:36 AM
No I am not advocating holding the patient during defid the reason for posing the question is
Should we continue CPR during the charging phase. As you would be aware there can be a long period of no CPR between analyzing and defibrillating. This could be reduced by performing compressions during the charging phase. I am looking for evidence not just because someone is paranoid.



PS no I am not dead

Bones42
09-28-2006, 09:24 AM
On my AED, if you start compressions during the "charging" phase, the AED will interpret this as a rhythm, drop the charge, and not shock.

IMO, compressions during the charging phase are a bad idea.

dbbeal
09-28-2006, 09:35 AM
most aed will analise for six seconds during this time they will react to movement however once analised they will commit to a charge regardless of rythm change.

needlejockey
09-28-2006, 11:07 AM
I don't think it's that long of a time really. It seems long when you're donig CPR, but in all reality its a matter of seconds.

Firescueguy
09-28-2006, 12:02 PM
Quite honestly, you seem to be overthinking the whole process...do what your training has taught you according to ESTABLISHED standards...attach AED, remove anyone from touching the pt., press analyze and let the machine do its' job. As Bones said, if you start pumping during the charging phase, the AED may interpret that as a rhythm and dump the charge.

It sounds as though you may not have much experience using an AED (no disrespect, that's not a "dig" just my thoughts judging by your questions/statements) because from the time the AED confirms a shockable rhythm, charges & is ready to fire, the downtime is minimal. Performing CPR during the charging phase (which is not the way AHA teaches CPR) would not only most likely cause the AED to dump the charge but would also delay the application of a shock by taking time to get everyone clear of the pt.
BEFORE analyzing/charging, you should ensure that yourself, your crew, family members and any equipment is clear of the pt. and then confirm that again BEFORE administering the countershock. If not doing so already, you (or the ONE person assigned to operate the AED, notice the emphasis placed on ONE, there should not be multiple technicians operating the AED) should be announcing in a firm tone of voice "I'm clear, you're clear (the crew), pt. is clear (their arm not laying across your partner's leg)...SHOCKING"...this should be said as you are LOOKING to ensure these things...it's not just some cute slogan someone came up with. Same idea as look, listen, feel...this is just look, listen & THINK...

Here's a big issue...AHA establishes the standards for CPR/AED and this is the established standard of care - if you decide to "try out" new ideas that are not approved/proven and the pt. suffers, you will be in for a world of hurt. Even the lawyer who finished dead last in law school knows that there are established policies/procedures for treatment and if you deviate from them simply because you wanted to try something new that you "thought might work", you could be considered to have neglected the pt's needs.

Let me just end this by saying that I'm not trying to rag on you here - I am all for going the extra mile for the pt. and if there's anything we can do that will increase their chances, then I'm all for it. What I am against is trying to "out-think" the established treatment that has been proven to work. If you truly want to do the right thing by the pt., then know your stuff, get good QUALITY CPR going, attach the AED, let it analyze and do its' thing...trying to add a set of compressions in is not going to add anything to the mix except the increased potential for a crew member to get hurt from some overzealous EMT (you know the one, the ink is still wet on his card :D) who wants to play Johnny Gauge & shock someone...CLEAR!!!! :eek: ..."oops, did they mean you guys should be clear too... :confused:

Oh one more last nugget of information regarding AED's - if you arrive to an MVA/MVC/wreck (whatever you call it in your area) with an entrapped pt. in arrest and someone happens to apply the AED which charges to shock (this was a medical arrest not traumatic), DO NOT push the shock button!!!! :eek: Yes, we had a guy locally who did this...dispersed 200J among the pt., himself, 2 other EMT's and 3 FF's who were just inserting the metal tips of their jaws into the car door...if you do the math (I just did), each person (including the pt. who really needed it) got about 28.5 joules each. .. :rolleyes:

Just my 3 cents...Stay Safe...and remember, electricity is unforgiving so respect it and act accordingly on scene as if your life depended on it...because it does... ;)

dbbeal
09-28-2006, 05:26 PM
With recent changes in Australian resus guidelines more emphasis is placed on good continuous resus. My service also has a trial running at present in essence if the rhythm is shockable then you open a card either immediate shock or three minutes of cpr first.


If we don’t question how we work we just do the same thing and fail to grow

Bones42
09-28-2006, 06:06 PM
Interesting. Around me, the emphasis is on good continuous compressions until the AED is in place, then let it do it's job, then more compressions if necessary.

Bushwhacker
10-02-2006, 12:40 AM
Watched a Para-med **** his pants because he shocked a patient in wet grass...Yes there is a possiblity for shock, use your head.

Dave1983
10-03-2006, 11:43 AM
Ive both seen it and felt it. But as others have said, that was back in the day with LP5's and hand-held paddles. Havent seen or heard of it since we switched to LP10's years ago (now 12's) with the fast patches.

medic27205
10-15-2006, 08:42 PM
No I am not advocating holding the patient during defid the reason for posing the question is
Should we continue CPR during the charging phase. As you would be aware there can be a long period of no CPR between analyzing and defibrillating. This could be reduced by performing compressions during the charging phase. I am looking for evidence not just because someone is paranoid.



PS no I am not dead

The new AHA Healthcare CPR/AED standards are saying to stand clear during the "Analyze" phase because motion can be falsely interpreted by the AED as a shockable rhythm. They go on to state that during the "charging" phase that you should continue CPR... but we have found that we only get in a few compressions before it is time to deliver the shock. But atleast you are "trying" to stay within the AHA guideline of interuptions in CPR to less than 10 sec.

zebra7
10-19-2006, 01:19 PM
Actually new AHA wording supports compressions until device is ready to fire (manual defib). Partner should hit charge while you do compressions, then stop and zap right away.
The time that elapses from your last compression to defib discharge is crucial. Limit it as much as possible. I reference a study that showed a 3% increase in mortality for each second that passes after your last chest compression. It's all about coronary perfusion pressure and quick shocking. Thus far, it seems that at least 15mmHg are needed for defibrillation increase success of defibrillation.

I always train AED users to continue compressions while another person places the pads, do not stop until the device goes to analyze. All to often people stop compressions when the AED arrives at the victim. This is not good practice!!!

Zeb7

mjcromis
10-20-2006, 10:33 PM
I know my department still has the old CPR training video on shocking patients. Anyone else remember this?

"I'm clear! You're clear! We're all clear!"

Good phrase to live by. Like many others on here, I haven't heard of anyone being shocked touching a patient, but never hurts to play it safe. :cool:

For those wondering, no I haven't been through the new guidelines for CPR.