Ep 215 Cardiac Arrest Update: Beyond the 2025 Guidelines Part 1: CPR, Defibrillation and Ventilation
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Mar 25, 2026 Dr. Rob Simard, emergency physician, educator and POCUS expert known for teaching point-of-care ultrasound and resuscitation, joins to unpack cutting-edge cardiac arrest care. They tackle CPR quality failures and real-time fixes. They debate head-up CPR, defibrillation timing and vectors, dual-sequence defibrillation logistics, and preventing harmful hyperventilation.
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Current Not Energy Is The Key To Successful Shocks
- Effective defibrillation depends on delivered current, which is influenced primarily by transthoracic impedance and pad vector, not just joules.
- Using high-energy strategies (e.g., 200J or 360J depending on device) increases current and termination success.
Use Rapid Wax Technique For Hairy Chests Before Shocking
- For hirsute chests, place pads, press firmly, then rip them off to remove hair and apply fresh pads, or use manual paddles with firm pressure if available.
- Carry razors in AED/ED kits to prep chest when needed.
Use DSED Or Vector Change Early For Refractory VF
- For refractory VF after standard shocks, apply DSED or vector change after early failed shocks, with trained workflows to avoid CPR interruptions.
- Log-roll and place posterior pad quickly, then deliver sequential paired shocks with minimal pauses.