Many medical students are shocked when they find out that most medical "miracles" don't work/happen the way we think. This troper's father said (sarcastically) he went to medical school to wear the cool doctor hat things; rub the defibrillator paddles together, yell clear and save someone; and find out why we hiccup. He was quite... annoyed when he found out that his class was the first to not use the doctor hat things, that rubbing the defibrillator paddles together scratches them, and that no one had a decent explanation for hiccups.

There is a reason for rubbing the paddles together. Before defibrillating someone, electroconductive gel is applied to the paddles to prevent the paddles from burning the patient's skin. Since it comes from a tube and squirts out in a big glob, rubbing the paddles together (gently, not like on TV) helps to make sure that both paddles are adequately covered.

And even with conductive pads there can be burns. This troper saw a family member being defibrillated by an AED repeatedly - it took 5 rounds of shocks, adrenaline and CPR to get him stable enough to get in the ambulance. Afterwards (he survived amazingly enough!) he had burns on his chest, and the wet pavement he was lying on ''was bone dry''.

Somewhat subverted with modern [=AEDs=] and Defibrillators. Most don't come with paddles anymore unless they are designed to be used in hospital, they come with combination pads that allow Pacing, Synchronized Cardioversion, Defib, and Lead II monitoring.

And some units even include inputs for pulse oximetry and 5-electrode EASI (next best thing to a 12-lead). Our unit got more use as a portable monitor for taking post-op heart patients up to the med/surg floors, rather than as a defibrillator.

No paddles were involved the one time this medical student troper saw (properly prepared) people get defibrillated. Instead some newfangled sticky pads with pictographic instructions were used. There was some disappointment.

The sticky pads are often found on consumer-grade field units now becoming popular with malls and other public places, which are A. Only designed to be used once before being sent in for recharging and repairs...you don't get the pads back once you've stuck em on someone and B. Designed to be used by security guards with minimal medical training who happen to be the first on the scene, hence the pictographs. Newer ones even talk you through it (more or less. Haven't seen one that reminds you to shave the patient and beware of piercings). Current AED protocol where this troper is from also recommends just one shock: after all, you need to pause CPR to administer the shock, and if the first one didn't help...

On defibs where paddles are still used, sticky conductive pads are supplied to put between the paddles and the patient's skin.

Along the same lines, many student healthcare professionals are disappointed to learn that not every rhythm is shockable. The various tachycardias and fibrillatory conditions respond well to cardioversion; asystole (flatline ECG) does not. Shocking asystole is a common sin among medical dramas, which attempt to use the ominous-looking flatline and monitor squeal to play up the criticality of the patient's condition, and then have the patient miraculously come back to life with a hit from the paddles. In real life asystole is treated by effective CPR, Airway Management, Epinephrine and correction of what is known as the "6 Hs and 5 Ts," the mnemonic list for easily correctable causes of PEA and Asystole. Pacing is no longer recommended by ACLS, as it's ineffective. Asystole has an abysmal survival rate, and defibrillating it makes that even worse.

4Hs and 4Ts are taught as the reversible causes of arrest in the UK - Hypoxia, hypovolaemia, hyper/hypokalaemia, hypothermia, toxicity, tamponade, thrombo-embolism and tension pneumothorax. This troper renewed his ILS qualification last month.

US ACLS guidelines also give Hypoglycemia (rare in adults - more a pediatric cause), "Hydrogen" (acidosis) and "The Big One" (massive myocardial infarct).

This troper's EMT preparation class recently went over defibrillation and he was disappointed when saw what modern AED's look like.

Agreed. Our [=AEDs=] looked like Fisher Price toys and didn't have any cool buttons or anything. I was also surprised to hear the mortality rate for asystole, because on TV any good zap seems to bring people back to life.

And there are internal defib paddles, designed to be used (at lower energy levels) directly on the heart surface. Seeing these in action is ''memorable'' to say the least.

Patients do tend to jerk a bit when you deliver a shock, but they don't convulse off the cart. Nevertheless, this troper was quite impressed upon seeing equipment wrappers fly out of the sheets during her first code.

A football player in Texas suffered a very rare medical condition during an away game in which is heart ''stopped beating''. He was on the bench during the middle of an away game, when he just suddenly fell backwards. While the team brought along a defibrillator and his parents were doctors (the away team being a rich Austin suburb), he had to spend a few weeks in the hospital (the home team's hospital), get an internal defibrillator installed in his heart, and end his fledgling football career.

Played literally with this troper's LARP character, who lay comatose in a healing pool after being stabbed 27 times on his second adventure. It was a shocking grasp spell that woke him back up from his pseudo-death.