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Re: Conscious VTAC

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This e-mail, facsimile, or letter and any files or attachments transmitted with

it contains information that is confidential and privileged. This information is

intended only for the use of the individual(s) and entity(ies) to whom it is

addressed. If you are the intended recipient, further disclosures are prohibited

without proper authorization. If you are not the intended recipient, any

disclosure, copying, printing, or use of this information is strictly prohibited

and possibly a violation of federal or state law and regulations. If you have

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>

> How plausible does this scenario sound?

>

> 1. Patient is UNCONSCIOUS. Because the patient is unconscious

> and unresponsive, an AED is attached and turned on. It may or

> may not shock.

Surely the rescuer would have made an attempt to assess for pulses

(maybe not with a lay-person) or breathing. If both of these were

present, I don't understand why an AED would be attached in the first

place. The recovery question and calling 911 sound like better

options to me.

> 2. Patient WAKES UP. Either they were shocked and became conscious,

> or just woke up spontaneously, but AFTER the AED was attached,

> they WOKE UP.

See comment under point 1.

> 3. AFTER waking up, WHILE conscious, the AED says SHOCK. We are

> assuming V-tac, but all we really know is the unit says SHOCK.

>

> For this to happen, we have to have a conscious patient in wide-complex

> v-tac over about 120 bpm, according to some of the units I've

> found specs for. How feasible is that?

>

It sounds feasible. However, I believe I would defer answering this

in favor of the physicians on this list.

Regards,

Alfonso R. Ochoa

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>

> Kenny,

>

> I don't think so in this case. Remember, this is a LAY responder.

> They are not taught to check pulse, per current guidelines.

> And, the unresponsive patient has AED applied immediately, before

> circulation check anyway. Unresponsiveness is the key.

>

Lay persons are taught to check for signs of circulation (ie

breathing) as per the AHA. Sounds like this person jumped the gun in

this case.

> But the question is still there. How common is conscious wide-complex

> v-tac? I've seen conscious patients in V-Tac a few times over

> the years. But not knowing the specificity and the parameters

> the AEDs use to determine if it's shockable is a problem.

>

Depends on many things. I personally have picked up numerous patients

who seemed to be in wide-complex VTACH until I noticed a small " spike "

between the wide QRS complex. A personal observation of mine which

may be way off is the newer models of pacemakers have little to no

spikes before the QRS when compared to the older models. Thus, it's

very possible that the AED might have been tricked into thinking it

was VTACH when in all actuality it was a ventricular paced rhythm.

Regards,

Alfonso R. Ochoa

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