What should I do when the defibrillator advises a shock, however the rhythm I see (and confirm with my partner) is PEA? Am I allowed to disarm a shock that I belive the monitor is mistakenly picking up artifact and suggesting a shock when it is unwarranted?  

Thank you for the excellent question. There are many circumstances where a medic will note artifact in the prehospital environment, that could be analyzed by the SAED as a shockable rhythm (when really it is only artifact) when the true underlying rhythm is noted to be non-shockable by the paramedic. If a paramedic does not believe the analysis, it would be reasonable to withhold defibrillation. 

Instances of artifact include: with patient movement and multiagency responses bumping patients during the analysis phase, with patient transport while driving, patient location beside a big generator or large motor (i.e. location a few feet from a large fire truck can cause an electromagnetic field causing interference and send a fine VF like wave distorting asystole).  

However, please keep in mind that a rhythm that is shockable and is not shocked has greater impact on mortality than a rhythm that is shocked that shouldn’t have been when a patient is in cardiac arrest 

 In all of these situations please document your decision-making well on the ACR so we can best understand the circumstances to best support you. 

Cardiac/Circulation,Medical Cardiac Arrest

Artifact, defibrillation, Manual defibrillation, SAED, Semi-automatic Defibrillation

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