Jastewart

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Please sign your name on talk pages using four tildes (~~~~); this will automatically produce your name and the date. If you need help, check out Wikipedia:Questions, ask me on my talk page, or place {{helpme}} on your talk page and ask your question there. Again, welcome! Xiner (talk, email) 01:23, 4 March 2007 (UTC)

Hello. Please don't forget to provide an edit summary. Thanks, and happy editing.

Xiner (talk, email) 01:23, 4 March 2007 (UTC)

Shocking asystole

Regarding the practice of shocking asystole in case it is actually very fine VF, may I please know what evidence you're referring to? All sources I've read suggest it's more myth (that VF can be isoelectric to the point of looking like aystole) than reality. The likelihood of shocking fine VF into something other than asystole is already low (hence the new emphasis on CPR prior to defib with down times > 4 minues when no CPR has been performed prior to EMS arrival). If anything, I would think that shocking asystole would be a Class III intervention because it stuns the myocardium and delays CPR. Best, MoodyGroove 20:37, 4 March 2007 (UTC)MoodyGroove

I apologize for the delay. Unfortunately, I have read nothing on your website or the worksheet that changes my view. To me it's a philosophical question about the meaning of "primum non nocere" as well as the need to base modern treatments on the prevailing evidence. Some areas I found troubling:

The argument ends with the statement that ``studies of shocks for asystole have detected no improvement in survival. However, prohibiting a treatment on that basis, if applied consistently, would call into question the entire ACLS algorithm for asystole, including the use of atropine for asystole with which the argument started.

Perhaps so, but two wrongs don't make a right.

In addition to its import for individual cases, a prohibition on shocking asystole emphasizes specificity beyond its true clinical importance and strengthens the mindset that defibrillation depends on a sophisticated differential diagnosis of the monitor pattern, either by a caregiver with advanced training or by a computer algorithm. In so doing, it presents at least a small additional obstacle to achieving widespread rapid defibrillation. The greatest public health threat associated with defibrillation is simply delaying it. The major purported danger of shocking asystole lacks a scientific basis, and the chance of an inappropriate shock significantly injuring a patient is miniscule when compared to the dangers of defibrillation delayed or denied to patients in VF.

I am not convinced that a real danger exists. All we have are rare anecdotal cases where individual physicians claim that shocking asystole resulted in a perfusing rhythm. I could give you dozens of anecdotal cases where shocking fine VF resulted in asystole. Of note, we are no longer shocking VF when the downtime is > 4 minutes and no CPR has been performed prior to EMS arrival (and lets face it, most patients in fine VF have been down for a while). If you perform 2 minutes of CPR (with or without ventilations) and the patient is still showing asystole (and there is no obvious hypothermia, drug overdose, trauma, etc.) then perhaps an empiric shock would be defensible (as a last ditch -- "what could it possibly hurt" intervention). But prior to that? I'm still not convinced that shocking asystole is a good idea. I have NEVER seen fine VF shocked into sinus rhythm, let alone asystole shocked into sinus rhythm. However, we have been having success with aggressive chest compressions prior to the first shock. I do not believe the evidence (or lack of evidence) warrants a Class IIa or even a Class IIb recommendation for shocking asystole. At best, I think a Class Indeterminate would be appropriate (again, after 2 minutes of CPR). This is just my opinion. I applaud your interest in resuscitation research. Respectfully, MoodyGroove 00:12, 30 April 2007 (UTC)MoodyGroove