Loaded Gun

How do you defibrillate your patients in cardiac arrest?

Does this sound familiar?

Arrive on scene, make certain CPR is being done while you take out the defib pads.

Apply the defib pads.

Stop CPR for a moment to check the rhythmn.

It’s Vfib.

Continue CPR while you charge the defibrillator.

Defibrillator charged.  Stop CPR.  Clear!


Right back to CPR.

Sound familiar?  It’s how I’ve been doing it ever since the word when out to compress while charging.

Recently I did 6 mock cardiac arrests in a row, as part of a sim lab session involving medical students.  The med students interviewed a patient having chest pain, and then once he went into arrest, they called the paramedics, and yours truly came through the door.  Six times I came through the door.  And saved all six patients after the third shock in each case.  Its a STEMI, start hypothermia and off to the cath lab!

In the sessions, I focused on the students maintaining compressions, butI have to tell you, I always found the arrests seemed a touch ragged in the segment between stopping to identify v-fib, then restarting CPR while charging, and then stopping again moments later for the shock.

Now check out this way.

Arrive on scene, make certain CPR is being done while you take out the defib pads.

Maintain CPR while you apply the pads and charge the defibrillator.

Stop CPR.

Check the rhythm.

It’s Vfib!



See the difference?

Only one pause.  Not two.

Anticipate V-fib.  Charge your defibrillator prior to the rhythm check.

You will only have to interrupt CPR once each sequence.  This will increase hands on the chest time.

Do the rhythm check with a loaded gun and be ready to fire when you see v-fib.

Note:  I wish I thought of the above on my own, but I saw it in the video below, (which I highly recommend in itself).  I didn’t pick up on the loaded defibrillator point, until the 2nd time I watched it.

Maybe many of you have been doing this all along. If so, then I am pleased to join you.

ACLS 2013 from Resuscitation 2013 .

by Amal Mattu.


Leave a Reply to PGHMedic Cancel reply

Your email address will not be published. Required fields are marked *