What joule setting should be used on a bi-phasic defibrillator during unsynchronized conditions for the treatment of V-tach?

For the treatment of ventricular tachycardia (V-tach) in unsynchronized conditions, the appropriate joule setting on a biphasic defibrillator is typically in the range of 150-200 joules. This range has been established based on clinical studies that demonstrate effective defibrillation rates and minimal myocardial injury when using biphasic energy levels. Biphasic defibrillators are designed to deliver energy in a two-phase manner, which enhances the efficacy of the shock and reduces the needed energy level compared to monophasic defibrillators.

Utilizing a setting of 150-200 joules ensures that enough energy is delivered to successfully depolarize the myocardium and interrupt the re-entrant circuits causing V-tach. Lower settings, such as those in the ranges of 50-100 joules and 10-25 joules, are generally insufficient for effective defibrillation during V-tach, as they may not provide enough energy to achieve a successful conversion. Higher settings like 300-360 joules are typically reserved for specific clinical scenarios or for monophasic defibrillators but are not recommended as first-line treatment for V-tach with biphasic devices since they could pose a higher risk