About this episode

In this episode, Sarah Lorenzini discusses the complexities of ventricular fibrillation and the science behind defibrillation failures.

Sometimes V-fib doesn't respond to the shock at all. Sometimes it converts and comes right back. Those are two completely different problems. In this episode, Sarah breaks down the science behind why defibrillation fails, how to recognize the difference between refractory and recurrent V-fib, and respond when shocks aren't working. You'll learn how to start approaching the electrical storm at the bedside — that means understanding transthoracic impedance, optimizing your pad placement, and knowing when to reach for double sequential defibrillation. Topics discussed in this episode: Refractory vs. recurrent V-fib The physiology of ventricular fibrillation and re-entry tachycardias Misconceptions about defibrillation Transthoracic impedance and how to reduce it Anterior-lateral vs. anterior-posterior pad placement Double sequential defibrillation: evidence and objections Key findings from the DOSE VF trial American Heart Association. (2025). 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care . Circulation. Cheskes, S., Dorian, P., Feldman, M., McLeod, S., Scales, D. C., Pinto, R., Turner, L., Morrison, L. J., Drennan, I…

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