Can You Commit Suicide With an AED?

Recently, my husband and I have been binge watching through all five seasons of breaking-bad-s5-400x600-compressedv1Breaking Bad. In the last season, a gentleman decided to kill himself using an AED.

AED stands for Automatic External Defibrillator. It is a quick rescue device used mostly by non-medical people for cardiac arrest. It is designed to recognize lethal heart arrhythmias and deliver a shock (electricity) if the patient is in one. The AED will not always fire. In fact, there are really only two arrhythmias it is designed to treat.

The question becomes, can you use an AED to commit suicide? An AED has two large, white patches connected to the device. In the show, the gentleman places one patch on his chest, pulls off the other patch and places the exposed wires in his mouth. After this, he turns on the device and discharges it, thereby killing himself.

aedThis scenario is highly improbable and here’s why:

1. Both patches must be in place for the defibrillator to analyze the patient’s rhythm. If they’re not, the machine will not progress any further.

2. Let’s say the AED would read the rhythm (one patch on the chest and exposed wire in the mouth)— it won’t deliver electricity for a normal rhythm (which this gentleman likely has because he’s alert and conscious.)

3. Let’s say the AED did fire for his normal heart rhythm— would he die? There is a slight chance that he might die, but only if the AED fired during a very sensitive time in the electrical cycle of his heart which has a very low probability.

All in all, I don’t find this method of suicide possible. Sorry, Breaking Bad, though I did love the series.

Author Beware: Use of Electricity

Authors, television producers and scriptwriters are fascinated by the use of electricity. This is probably one of the most commonly abused medical scenarios in that it is rarely used correctly.

One of my most popular posts here at Redwood’s was a post titled Shock Me To Death that highlights how electricity (or defibrillation) should be used.

I was reading a debut novel by a medical doctor and found many grievous errors around the use of electricity. Which distresses me because he also said he had a cardiologist review the manuscript. Seriously, I kind of want to know who that doctor is and what kind of training he had.

There was the usual error of shocking a flatlined patient or asystole. Remember, in order for electricity to work, there has to be some present. If a patient is flatlined, there is no disorganized cardiac rhythm to reset and so defibrillation is contraindicated in those patient scenarios.

Next error in this manuscript was cracking the sternum down the middle during compressions. For one, the sternum is extremely hard to fracture. It’s designed to protect some very important organs. If the sternum is even slightly fractured, we know there have been extreme forces placed on that patient. So, to have mere hands fracture a sternum all the way down the middle is ludicrous. Remember, they saw this open for open heart surgery. Breaking ribs is very probably during CPR, but not the whole length of your sternum . . . sorry.

Last, and most creatively (as I’d never seen this error before), was the amount of electricity used in an ICD device (an implanted cardiac defibrillator.) ICD’s are devices that are used to convert patients from lethal arrhythmias like v-fib and v-tach. They are not pacemakers– which stimulate the heart to beat.

Whenever electrodes are placed near the heart, the amount of electricity used is very small. Think about it. When we shock you from the outside of your body, the electrical current has a lot of tissue to pass through to get to your heart. This is why we use more. When defebrillating someone– it’s in joules.

A pacemaker uses a lot less energy. Outside pacemaker use milliamps.

And here is the very interesting quote from a published novel:

“Cardiologists shock patients all the time under controlled conditions, remotely dumping up to 700V (volts) of juice directly in to the heart via the ICD.”

Wow. That’s just . . . overkill.

Just how lethal is 700 volts applied directly to the heart?

This site explains that 110V can kill you.

It’s so egregious an error that I’m not quite sure what this author was thinking. It pains me more that he is an actual medical doctor. I even double checked the published manuscript (as I’d read a galley proof before) and the error was still present.

I think he needs a new cardiologist.

Shock Me To Death

There’s nothing like watching a TV show and seeing medical personnel come in with the paddles (even these are rarely used) to shock a patient. Many people say this is “jump-starting” the heart and this is really the wrong clinical picture to give as far as medical accuracy is concerned. The use of electricity on the heart actually stalls it.


How could that possibly be helpful to a patient?

Heart cells are very unique, cool little contraptions. Each cell in your heart can generate a beat. Yes, that’s right, every little teeny one. Most often, the normal conduction system of the heart overrides this unique property of heart cells, and the electricity flows from the AV node to the SA node so the heart contracts in a normal, orderly fashion.

Heart Cells: Douglas Cowan, Children’s Hospital Boston
The heart’s normal beat is important because when the top (the atria) contract, it pushes the remaining blood that doesn’t flow via gravity when the valves open into the ventricles. When the ventricles contract, it pushes blood out to the rest of the body.

The purpose of blood flow is really oxygen delivery to the cells. Of course, there are other functions but this is primary. Without oxygen delivery to the cells, cells will die. Lack of oxygen delivery to the cells is called shock.

We’ll talk more about shock in later posts.

Defibrillation (or unsynchronized cardioversion) is only used in a few arrhythmias. Ventricular tachycardia and ventricular fibrillation. These arrhythmias appear when something has affected the heart’s normal conduction system– such as a heart attack, electrical injury, lack of oxygen. They are more common to the adult population than to the pediatric.

In these arrhythmias, the heart’s normal conduction system is no longer working properly and other cells in the heart become active in an attempt to keep the patient alive. The problem with these arrhythmias is that they do not produce a pulse.

No pulse is clinical death. So, we must get back the patient’s pulse back in order for them to have a chance at survival.

What defibrillation actually does is stop the heart by briefly terminating all electrical activity in hopes that the heart’s normal conduction system will begin to work and a palpable pulse will then ensue.

Important note— there must be some electrical activity for defibrillation to work. So, it is not indicated for the treatment of asystole or when the patient has “flatlined”. This is done often in television shows and is a clear medical inaccuracy.

Electricity is also used in another condition called supraventricular tachycardia (SVT). Supra means above. So this rhythm is a very fast rhythm generated somewhere in the atria. Sometimes, when the heart beats incredibly fast, it doesn’t have enough time to fill with blood. When it fills with less blood, it pumps less blood out. Less blood out means less oxygen delivery. The patient can have signs and symptoms of lightheadedness, dizziness, sweating, chest pain, and difficulty breathing to name a few. They still have a pulse though it may be weak and thready.

The goal of using electricity in this instance is again to disrupt this pathway by stalling it in hopes that the heart’s normal conduction system will take over at a much slower rate.

There is also a medication that can be given that will chemically stall the heart, too. It is called adenosine and is used in the stable patient presenting with SVT. It is used in instances of fast rhythms to slow the pulse down.

Does this change your impression of how defibrillation really works?