Advanced Cardiovascular Life Support (ACLS) Practice Exam

The recommended initial joule setting for biphasic defibrillation is typically in the range of 120-200 joules. This range is based on clinical studies that demonstrate effective outcomes while minimizing potential myocardial injury. Biphasic defibrillators deliver the shock in two phases, reversing the polarity halfway through the discharge, which allows for greater efficiencies in terminating ventricular fibrillation or ventricular tachycardia compared to older monophasic defibrillators.

The exact energy setting can vary depending on the specific biphasic defibrillator being used, as manufacturers may have different recommendations. However, the range of 120-200 joules has general consensus within guidelines as the initial shock for most adult patients and is aimed at achieving maximal effectiveness in rhythm conversion with the least risk of harm. This reflects a balance between the need for sufficient energy to disrupt the abnormal electrical activity of the heart while avoiding excessively high energy levels that could cause complications such as myocardial damage.