bi phasic defib

["ROSEMARY E. ADAM" <REA034@UIHCJES2.UIHC.UIOWA.EDU>]

This question just came up in our area so I contacted our experts.  The
companies who manufacture the biphasic machines offer their "dial down"
formula for adult (>8)defibrillation but don't offer advice on either
Peds or cardioversion energy levels.  This is what our Peds Cardiologist
said (Atkins:she's done several of the AHA studies, published, etc.)...

Follow the AHA guidelines for monophasic machines right now on all bi-
phasic models in kids.  She is sure (but can't prove it) that we are way
too conservative on energy levels in kids so the biphasic (more applied
energy) is OK.  SO: 0.5-1.0 J/Kg in cardioversion, 2-4J/Kg defib.

Regarding cardioversion in adults, there is one good study using
biphasic energy in a patient with atrial fibrillation and they found
that 200 joules was best.  Go figure.  Our (Kerber)expert who has
done the most studies on biphasic machines says for right now to use the
old ranges for monophasic machines in biphasic for cardioversion in
adults.

Rosemary Adam, RN/EMT-P
Air Care
The University of Iowa Hospitals
Iowa City, Iowa

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