Reference pressing down to decrease electrical impedance: the defibrillators we use (Likepak 20s) still have the external paddles on them. While we use disposable pads for difibrillation and cardioversion, I will sometimes take the unplugged paddles and press down on the anterior pad (if using AP placement) during cardioversion to decreased impedance. If the paddles are available I'd certainly recommend this over the rolled up towel approach since they're made specifically to be insulated against the electricity. Our monitor strip that prints after the synchronized shock is delivered lists amount of impedance so it's interesting to see the number drop significantly when you press down on the pad compared to when you do not. I think I'll be considering this same technique to decreased impedance during defibrillations in the future as well. Great info!
RE Is it or isn't it a STEMI - in the case discussed it seems that the emergency physician met the standard of care but the case ended with him paying a settlement to the plaintiff. This was presented as if it were a reasonable outcome. Settling a claim is not benign - it is reported to the National Practitioner Data Base as if it were a judgement of malpractice. The settlement needs to be explained on every license and credentialing application, forever. The doctor's malpractice premiums will increase for years, as may those of his associates, because the group paid a claim, and paying settlements in cases where the standard of care was met rewards extortionist attorneys.
I love the age adjusted d-dimer, however I wonder if that means we need to adjust the cut-off DOWN for younger patients. If an 80 year old should have a cut off of 800, then should a 20 year old have a cut-off of 200 - rather than continuing to use the standard 500?
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Shock, Asthma, and FingertipsFull episode audio for MD edition246:13 min - 343 MB - M4AEM:RAP 2016 June Canadian EditionCanadian18:39 min - 26 MB - MP3EM:RAP 2016 Junio Resumen EspañolEspañol91:44 min - 126 MB - MP3EM:RAP 2016 Juin Résumé en FrancaisFrançais58:51 min - 81 MB - MP3EM:RAP 2016 June Aussie EditionAustralian32:29 min - 45 MB - MP3EM:RAP 2016 June German EditionDeutsche122:57 min - 169 MB - MP3EM:RAP 2016 June Board Review Answers172 KB - PDFEM:RAP 2016 June Board Review Questions237 KB - PDFEM:RAP 2016 June MP3300 MB - ZIPEM:RAP 2016 June Written Summary809 KB - PDF
Jonah S., RN - June 1, 2016 10:31 PM
Reference pressing down to decrease electrical impedance: the defibrillators we use (Likepak 20s) still have the external paddles on them. While we use disposable pads for difibrillation and cardioversion, I will sometimes take the unplugged paddles and press down on the anterior pad (if using AP placement) during cardioversion to decreased impedance. If the paddles are available I'd certainly recommend this over the rolled up towel approach since they're made specifically to be insulated against the electricity. Our monitor strip that prints after the synchronized shock is delivered lists amount of impedance so it's interesting to see the number drop significantly when you press down on the pad compared to when you do not. I think I'll be considering this same technique to decreased impedance during defibrillations in the future as well. Great info!
james s. - June 17, 2016 9:19 AM
RE Is it or isn't it a STEMI - in the case discussed it seems that the emergency physician met the standard of care but the case ended with him paying a settlement to the plaintiff. This was presented as if it were a reasonable outcome. Settling a claim is not benign - it is reported to the National Practitioner Data Base as if it were a judgement of malpractice. The settlement needs to be explained on every license and credentialing application, forever. The doctor's malpractice premiums will increase for years, as may those of his associates, because the group paid a claim, and paying settlements in cases where the standard of care was met rewards extortionist attorneys.
Anand S. - June 17, 2016 9:25 AM
James - excellent point. Amazing what we call a "win" in the US.
Kathryn E. - August 4, 2016 4:49 PM
I love the age adjusted d-dimer, however I wonder if that means we need to adjust the cut-off DOWN for younger patients. If an 80 year old should have a cut off of 800, then should a 20 year old have a cut-off of 200 - rather than continuing to use the standard 500?