No your numbers ^^ are correct,the difference is what device is in use,the manual units are all adjustable so shocks can be given per circumstance ie cardioversion.
The AEDS may only shock at one preset and not stack the rest of the shocks.The semi AED can also be set manually but not in the same way as a manual defib.
Every province or Medical Director is different but more AED's are delivering the same joule amount every shock. Recent studies have shown that when you increase the shock amount over a period of time more damage is done to the heart muscles with little or no gain. Where has if you deliver the same amount joules at 200 it is just as effective without all the damage if it does occur. So when AMECA's show up and dip into their bag of goodies the patient has a better chance of leading a better life without as many complications.
This is why they also changed shock protocol to 2 minutes of CPR, shock, 2 mins CPR, shock, 2 mins of cpr, shock, cpr, cpr, cpr.
Sorry - everyone has one of those things that bugs them - my fulltime field deals with electricity, and when ordering, stuff like that is quite important (It can make the difference between stuff running properly, and a big BANG!)
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They have a bad habit of tossing the official ruling off to the manufacturer's recommendations. Zoll, Medtronic, etc all have their own recommendations when it comes what biphasic joules to shock at. Monophasic is a thing of the past and kills heart muscle.
The Advanced Cardiovascular Life Support program which is developed by the AHA, offers a 'guideline' of 200J for biphasic defibrillation. It also outlines specifics when it comes to Cardioversion, which are derived from studies regarding certain rhythms (a-fib, stable VT).
AED's and LP12's (AED Mode) come from the factory with standard settings. When you unpack them you enter the program mode and set the default settings to your services protocol, typically set by your medical director, typically following recent studies or ACLS guidelines.
For example, in a Physio Control product, you might select 360 joules but you dont actually know the amount of energy delivered due to a number of variables so it is 360 joules of equivalent energy. As it was already indicated, you can equal the level of joules through different means. (Joules (Energy) = Voltage X Current X Time), any number of combinations depending on the voltage, the current and length of time it is expelled.
It is becoming more standard practice to defibrillate once at the highest energy setting and not stacking shocks as the higher energy level has demonstrated a higher efficacy and often results in less defibrillations to overcome the fibrillation threshold.
Check this link, it simplifies it: http://www.resuscitationcentral.com/def ... -waveform/
Defibrillator manufacturers specify the recommended power settings for their equipment.
While Medical Directors are always free to determine the settings they wish used, for the most part doctors simply state to follow manufacturers recommendations.
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