Because the traditional "5H5T" or "6H6T" approach of PEA arrests is difficult to remember, a novel and easy-to-teach approach of PEA is recommended by using ECG monitor (determining QRS width) and POCUS (point of care ultrasound), as depicted in the above figure. This approach requires a skilled ultrasonographer and it should not interrupt high quality CPR.
Dual simultaneous external defibrillation
Also known as:
Double sequential external defibrillation (DSED)
Dual sequential defibrillation (DSD)
Use only in refractory or intractable ventricular fibrillation (VF) after multiple attempts (at least 3 to 5 attempts) at defibrillation and appropriate medications have been given.
Apply TWO sets of defibrillator pads to the patient; one in traditional sternum/apex configuration and the other in anterior/posterior configuration. Some protocols suggest firing the defibrillators "sequentially" (less than 1 second apart), others recommend firing "as synchronously as possible" (simultaneously).
Consider using high-energy, dual simultaneous defibrillation in patients with refractory VF only after high quality CPR, several attempts at defibrillation, and appropriate medications have been given.
This ESRD patient came to the ED because of herpetic neuralgia. She actually missed her regular hemodialysis appointment that morning.
How to treat hyperkalemia?