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Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
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Standardized Model of Ventricular Fibrillation and Advanced Cardiac Life Support in Swine
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Refractory Ventricular Fibrillation Successfully Cardioverted With Dual Sequential Defibrillation.

Rodney C Sena1, Samuel Eldrich2, Richard M Pescatore2

  • 1Rowan University School of Osteopathic Medicine, Stratford, New Jersey.

The Journal of Emergency Medicine
|July 3, 2016
PubMed
Summary

Dual sequential defibrillation, using two defibrillators simultaneously, successfully terminated refractory ventricular fibrillation in a cardiac arrest patient. This alternative strategy may be considered when standard Advanced Cardiovascular Life Support (ACLS) measures fail.

Keywords:
cardioversiondefibrillationdual sequentialrefractoryventricular fibrillation

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Area of Science:

  • Emergency Medicine
  • Cardiology
  • Critical Care

Background:

  • Current guidelines for cardiac arrest treatment are provided by the American Heart Association's basic life support and advanced cardiovascular life support (ACLS) courses.
  • Alternative strategies may be necessary when standard ACLS treatments fail to terminate lethal dysrhythmias.

Observation:

  • A 56-year-old woman presented with chest pain, nausea, and vomiting, with initial work-up showing no acute ischemia.
  • While under observation, the patient developed ventricular fibrillation, and ACLS was initiated.
  • Following four unsuccessful defibrillation attempts, dual sequential defibrillation was performed.

Findings:

  • Dual sequential defibrillation involves using two defibrillators simultaneously to deliver an increased energy waveform.
  • This technique resulted in immediate return of spontaneous circulation in the patient.
  • The patient recovered, underwent cardiac catheterization, and was discharged within a week.

Implications:

  • Dual sequential defibrillation may be a successful method for terminating refractory ventricular fibrillation.
  • Further research is needed to standardize the dual sequential defibrillation procedure.
  • Emergency physicians should consider this alternative when standard ACLS measures are ineffective.