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Rather than treating
all “shockable” rhythms with direct countershock, the current model of VF
arrest suggests that the optimal treatment changes over time. While the treatment for VF in the first 4
minutes is still a shock, very few OOHCA patients are reached in this
phase. The notable exception is
witnessed arrest patients, who should always be shocked immediately. The optimal therapy after 10+ minutes, when
the metabolic phase is reached, is still unknown. It is worth pointing out that the
morphology of VF appears to change over time, which is an observation that
most EMS providers have made before.
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