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Fascinating. I wonder is this one of those "medical myths" where there isn't any good evidence either way, and probably never will be good human evidence, as no-one in their right mind is prepared to try an elective cardioversion without syncing! AF ----- Original Message ----- From: "Andrew Stearman" <[log in to unmask]> To: <[log in to unmask]> Sent: Friday, July 01, 2005 12:28 AM Subject: Re: Pulseless VT I was told recently by a cardiologist that the risk of a non synchronized shock converting VT to VF was 5% and the risk of a sync shock converting VT to VF was ( wait for it ) 5% ( no reference though ) anybody seen any other actual percentages ? Andy Stearman ED staff specialist Newcastle ( NSW ) >>> [log in to unmask] 07/01/05 9:00 AM >>> ----- Original Message ----- From: "Jonathan Benger" Subject: Re: Pulseless VT > On the other hand, in pulsed VT you have a lot more time to sort out the > sync issue (and the complexes are usually readily recognisable by the > average defib). And not forgetting of course, that in "pulsed" VT you clearly must synchronise, as a random shock could "convert" it to VF. But that's a good point Jonathan, it takes time to sync and the machine may not be able to sync at all. A further reason would be that unless the practitioner is used to delivering sync shocks, they might think their machine's not working properly, as you inevitably get a split-second delay after pressing the buttons before the shock is delivered. This might put off the unwary (and I've seen that happen). It comes back to the KISS principle (keep it simple stupid) which is a sensible way to teach VF/VT management to all practitioners, especially those who aren't cardiology SpRs! I think I would have handled such a question by suggesting it would be just fine in his hands but might cause temporary confusion or unnecessary delay in the hands of a medical SHO, a CCU staff nurse, or a paramedic. AF