{"id":2808,"date":"2025-03-21T08:05:43","date_gmt":"2025-03-21T16:05:43","guid":{"rendered":"https:\/\/www.nicolekupchikconsulting.com\/news\/?p=2808"},"modified":"2025-07-01T13:03:04","modified_gmt":"2025-07-01T21:03:04","slug":"when-to-use-electricity-on-your-patients-rhythms-we-defibrillate","status":"publish","type":"post","link":"https:\/\/www.nicolekupchikconsulting.com\/news\/when-to-use-electricity-on-your-patients-rhythms-we-defibrillate\/","title":{"rendered":"When to Use Electricity on Your Patients &#8211; Rhythms We Defibrillate"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">So, it is the middle of the night, and you are new to the ICU and haven\u2019t had a chance to do your ACLS course.&nbsp; If your patient does code, how do you know which rhythms to shock or not? It can feel daunting not to know this information.&nbsp; Don\u2019t worry, I\u2019ve got you, bestie. This is a great question.&nbsp; Let\u2019s start by spelling out the rhythms we do shock or defibrillate, so this simplifies things.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Here are the rhythms we defibrillate:<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Ventricular Fibrillation (VF)<\/strong> <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>What is it?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In VF, the heart is quivering without organization.&nbsp; This is a fatal arrhythmia, and the key is early defibrillation.&nbsp; In this scenario, you would call a code, start CPR, attach the defibrillator pads, and get the defibrillator ready for early defibrillation. Typically, you will defibrillate with 120 &#8211; 200 joules on a biphasic defibrillator, but follow the manufacturer\u2019s guidelines.&nbsp; For the second shock, increase the joules. You can defibrillate every 2 minutes.&nbsp; Your 1st line drug is 1 mg epinephrine.&nbsp; An antiarrhythmic, such as 300 mg amiodarone, may be given if the rhythm isn\u2019t responsive to electricity.&nbsp; Follow the ACLS guidelines! <strong>&nbsp;<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-1 is-layout-flex wp-block-gallery-is-layout-flex\">\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"936\" height=\"411\" data-id=\"2823\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2025\/03\/Picture1-5.png\" alt=\"\" class=\"wp-image-2823\"\/><\/figure>\n<\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Ventricular Tachycardia (VT) <u>Without a Pulse<\/u><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">What is it? In VT, the lower chambers of the heart are beating too fast to provide adequate blood flow. It can be monomorphic or polymorphic in nature.&nbsp; This is also a fatal arrhythmia, and the key is early defibrillation.&nbsp; In this scenario, you would call a code, start CPR, attach the pads, and get the defibrillator ready for early defibrillation. Typically, you will defibrillate with 120 &#8211; 200 joules on a biphasic defibrillator, but follow the manufacturer\u2019s guidelines.&nbsp; For the second shock, increase the joules. You can defibrillate every 2 minutes.&nbsp; The 1st line drug is 1 mg epinephrine.&nbsp; An antiarrhythmic, such as 300 mg of amiodarone, may be given if the rhythm isn\u2019t responsive to electricity.&nbsp; Follow the ACLS guidelines! <strong>&nbsp;<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-2 is-layout-flex wp-block-gallery-is-layout-flex\">\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"975\" height=\"438\" data-id=\"2828\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2025\/03\/image-2.png\" alt=\"\" class=\"wp-image-2828\"\/><\/figure>\n<\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Torsades de Pointes (TdP)<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">What is it?&nbsp; In TdP, the lower chambers of the heart are beating too fast to provide adequate blood flow. It is polymorphic in nature and can deteriorate into VF. TdP is associated with long QTc intervals.&nbsp; When pulseless, the key is early defibrillation.&nbsp; In this scenario, you would call a code, start CPR, attach the pads, and get the defibrillator ready for early defibrillation. Typically, you will defibrillate with 120 &#8211; 200 joules on a biphasic defibrillator, but follow the manufacturer\u2019s guidelines.&nbsp; For the second shock, increase joules. The 2nd priority would be administering a 2 mg Magnesium slow IV push.&nbsp; Follow the ACLS guidelines! <strong>&nbsp;<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"624\" height=\"141\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2025\/03\/image.gif\" alt=\"\" class=\"wp-image-2819\"\/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Asystole\/PEA &#8211; Rhythms we do NOT defibrillate:<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">As far as the other rhythms in an arrest scenario, if there is no pulse present, it is either asystole or pulseless electrical activity (PEA).&nbsp; PEA can look like an organized rhythm, such as normal sinus rhythm on the monitor, but if there is no pulse detected with a rhythm on the monitor, it is PEA.&nbsp; Reminder: We do not shock PEA or asystole.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-3 is-layout-flex wp-block-gallery-is-layout-flex\">\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"624\" height=\"48\" data-id=\"2821\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2025\/03\/image-2.gif\" alt=\"\" class=\"wp-image-2821\"\/><\/figure>\n<\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">If you want more information on cardiac rhythms, please check out Nicole\u2019s on-demand course 12 Lead ECG Interpretation: An Easy Approach.&nbsp; If you want to grow your cardiac knowledge, Nicole\u2019s on-demand course, Cardiac Bootcamp, is just for you!&nbsp; Earn CEs, develop your skills, and grasp all things cardiac!<\/p>\n\n\n\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-4 is-layout-flex wp-block-gallery-is-layout-flex\">\n<figure class=\"wp-block-image is-style-default\"><a href=\"https:\/\/www.nicolekupchikconsulting.com\/booksAndCourses\/online-courses\/15\/cardiac-boot-camp\"><img loading=\"lazy\" decoding=\"async\" width=\"760\" height=\"420\" data-id=\"2830\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2025\/03\/Cardiac-Boot-Camp.png\" alt=\"\" class=\"wp-image-2830\"\/><\/a><\/figure>\n<\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Additionally, if you are looking for a helpful guide to Critical Care Nursing, peek at Nicole\u2019s <a href=\"https:\/\/www.nicolekupchikconsulting.com\/booksAndCourses\/books-bundles\/136\/critical-care-survival-guide\">Critical Care Survival Guide,<\/a> now also available in digital download.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-5 is-layout-flex wp-block-gallery-is-layout-flex\">\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.nicolekupchikconsulting.com\/booksAndCourses\/digital-download-detail\/154\/critical-care-survival-guide-digital-download\/\"><img loading=\"lazy\" decoding=\"async\" width=\"2000\" height=\"2000\" data-id=\"2833\" src=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2025\/03\/CCSG-1.png\" alt=\"\" class=\"wp-image-2833\"\/><\/a><\/figure>\n<\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>References:<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/emedicine.medscape.com\/article\/2172100-overview#:~:text=Shockable%20rhythm%20%3D%20Ventricular%20fibrillation%20or,%2Fpulseless%20electrical%20activity%20(PEA)\">https:\/\/emedicine.medscape.com\/article\/2172100-overview#:~:text=Shockable%20rhythm%20%3D%20Ventricular%20fibrillation%20or,%2Fpulseless%20electrical%20activity%20(PEA)<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.uptodate.com\/contents\/advanced-cardiac-life-support-acls-in-adults?search=ACLS%20shockable%20rhythms&amp;source=search_result&amp;selectedTitle=8%7E150&amp;usage_type=default&amp;display_rank=8\">https:\/\/www.uptodate.com\/contents\/advanced-cardiac-life-support-acls-in-adults?search=ACLS%20shockable%20rhythms&amp;source=search_result&amp;selectedTitle=8%7E150&amp;usage_type=default&amp;display_rank=8<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.uptodate.com\/contents\/overview-of-the-acute-management-of-tachyarrhythmias?search=torsades%20de%20pointes%20management&amp;source=search_result&amp;selectedTitle=1%7E150&amp;usage_type=default&amp;display_rank=1\">https:\/\/www.uptodate.com\/contents\/overview-of-the-acute-management-of-tachyarrhythmias?search=torsades%20de%20pointes%20management&amp;source=search_result&amp;selectedTitle=1%7E150&amp;usage_type=default&amp;display_rank=1<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>So, it is the middle of the night, and you are new to the ICU and haven\u2019t had a chance to do your ACLS course.&nbsp; If your patient does code, how do you know which rhythms to shock or not? It can feel daunting not to know this information.&nbsp; Don\u2019t worry, I\u2019ve got you, bestie. [&hellip;]<\/p>\n","protected":false},"author":11,"featured_media":2797,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[46],"tags":[],"ppma_author":[62],"class_list":["post-2808","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nurse-education"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\r\n<title>Rhythms to Defibrillate - Nicole Kupchik Blog<\/title>\r\n<meta name=\"description\" content=\"When nurses should use electricity on patients - Rhythms nurses should defibrillate\" \/>\r\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\r\n<link rel=\"canonical\" href=\"https:\/\/www.nicolekupchikconsulting.com\/news\/when-to-use-electricity-on-your-patients-rhythms-we-defibrillate\/\" \/>\r\n<meta property=\"og:locale\" content=\"en_US\" \/>\r\n<meta property=\"og:type\" content=\"article\" \/>\r\n<meta property=\"og:title\" content=\"Rhythms to Defibrillate - Nicole Kupchik Blog\" \/>\r\n<meta property=\"og:description\" content=\"When nurses should use electricity on patients - Rhythms nurses should defibrillate\" \/>\r\n<meta property=\"og:url\" content=\"https:\/\/www.nicolekupchikconsulting.com\/news\/when-to-use-electricity-on-your-patients-rhythms-we-defibrillate\/\" \/>\r\n<meta property=\"og:site_name\" content=\"The Blog - Nicole Kupchik Consulting and Education\" \/>\r\n<meta property=\"article:published_time\" content=\"2025-03-21T16:05:43+00:00\" \/>\r\n<meta property=\"article:modified_time\" content=\"2025-07-01T21:03:04+00:00\" \/>\r\n<meta property=\"og:image\" content=\"https:\/\/www.nicolekupchikconsulting.com\/news\/wp-content\/uploads\/2025\/02\/12-Lead-ECG-Interpretation-2.jpg\" \/>\r\n\t<meta property=\"og:image:width\" content=\"426\" \/>\r\n\t<meta property=\"og:image:height\" content=\"282\" \/>\r\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\r\n<meta name=\"author\" content=\"Nicole Johnson\" \/>\r\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\r\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Nicole Johnson\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\r\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/www.nicolekupchikconsulting.com\\\/news\\\/when-to-use-electricity-on-your-patients-rhythms-we-defibrillate\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.nicolekupchikconsulting.com\\\/news\\\/when-to-use-electricity-on-your-patients-rhythms-we-defibrillate\\\/\"},\"author\":{\"name\":\"Nicole Johnson\",\"@id\":\"https:\\\/\\\/www.nicolekupchikconsulting.com\\\/news\\\/#\\\/schema\\\/person\\\/0c7de326f89aaefd3f9f3f16e4c02a98\"},\"headline\":\"When to Use Electricity on Your Patients &#8211; 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