3-DC Shock deIibrillator

3.1 Theory of operation:
To understand how a deIibrillator can restart a stalled heart, we must know the
physiology oI the organ (the heart). The human heart has Iour chambers, which create
two pumps. The right pump receives the oxygen-depleted blood returning Irom the
body and pumps it to the lungs. The leIt pump receives the oxygenated blood Irom the
lungs and pumps it to the body.
The coordination oI the pumping action is critical Ior the heart to Iunction correctly.
The heart's right atrium is responsible Ior this control. In this region, a spontaneous
electrical impulse is created by the diIIusion oI calcium ions, sodium ions, and
potassium ions across the cell membranes. The impulse thus created is transIerred to
the atrium chambers causing them to contract, pushing blood into the ventricles. AIter
about 150 milliseconds the impulse moves to the ventricles, which causes them to
contract and pump blood out oI the heart. As the impulse moves away Irom the
chambers oI the heart, these sections relax. In a normal heart, the process then repeats
itselI.
DeIibrillation are designed to restore the normal sinus rhythm oI heart activity when it
is disturbed by accident or disease, medical intervention oI using electricity to stop
ventricular Iibrillation in a patient's heart ,by passing a large but short-lived
therapeutic dose oI electric current through the chest.
The electrical energy discharged to the patient in deIibrillator is provided by a large
capacitor that is charged over a period oI several seconds by rechargeable batteries or
by line power.


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3.2 Clinical usage:
An external deIibrillator can be operated at an emergency site or a hospital. The
operator Iirst turns on the machine and then applies a conductive gel to the paddle
electrodes or patient's chest. The energy level is selected and the instrument is
charged. The paddles are placed Iirmly on the patient's unclothed chest with a
pressure oI about 25 lb (11 kg). The buttons on the electrodes are pressed
simultaneously and the electrical discharge, which lasts less than 20 milliseconds
(msec), delivers a high-voltage shock oI approximately 2,000 to 4,000 volts to the
patient.
The patient is then monitored Ior a regular heartbeat. The process is repeated iI
necessary.

An audible and/or visible indicator on the deIibrillator inIorms the operator when the
capacitor is charged and the device is ready Ior discharge




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uslna hands free elecLrodesŦ

3.3 Reported problems
O ne problem associated with deIibrillation and cardio version is skin burns at
the paddle or electrode sites. First- and second-degree burns are especially
likely to occur during repeated deIibrillation attempts, which require
successively higher energies. Burns are usually caused by a high current Ilow
through a small area (e.g., edge oI deIibrillator paddles) and/or an increased
resistance (e.g., dried gel). Paddles must be pressed Iirmly against the skin
during deIibrillation (25 lb oI Iorce); when administering repeated shocks,
users should check paddles Ior adequate amounts oI gel beIore each
deIibrillation attempt. When using disposable electrodes, users should check
the expiration date on the package and the integrity oI the package (do not use
iI the package has been opened).

O Failure to deIibrillate a patient is common problem that can be caused by
1. deIibrillator malIunction,
2. poor electrode application,
3. inappropriate energy selection,
4. A cardiac physiologic state not conducive to deIibrillation.

O ost device problems are Irequently related to problems with the rechargeable
battery; thereIore, careIul attention should be paid to battery maintenance

Maintenance of ventilator:
O All deIibrillators should be checked periodically using the standards .we must
check
1. The integrity oI all cables
2. Grounding oI the equipment
3. The accuracy oI the stored versus delivered energy

O When a patient is to be deIibrillated, all other electrical monitors, unless
speciIied saIe Ior use in deIibrillation, must be disconnected

O For saIety oI operators, no contact should be made with the patient or the bed.

3.4 Comments about the technology:

O DeIibrillators will be improved to become saIer and more eIIicient. For
example, designers are continually improving the electrode design to reduce
the chances that the device operator will get shocked. A recent patent issued in
the United States describes an electrode system that uses a Y shaped cable Ior
iust this purpose.

O lectrode must be large because the propagated current wave Iorm is directly
proportional to the electrode size.

O Advances in the Iabrication oI integrated circuits will also make the devices
easier to use and more lightweight.

O Another important area oI improvement will be Iound in battery technology.
There is a new metal alloy that should greatly improve rechargeable battery
perIormance. The alloy can be incorporated into a nickel/metal hydride battery
to provide a signiIicant increase in capacity Ior storing charge.

O In addition to these areas oI advancement, improvements in deIibrillator
design such as the using oI more sensors to give vital inIormation about a
patient's condition must be done














3Ŧ5 keferencesť
1alife 1. Ventricular Iibrillation: mechanisms oI initiation and maintenance. Annu
Rev Physiol 2000; 62:2550.

Kwaku KF, Dillon S. Shock-induced depolarization oI reIractory myocardium
prevents wave-Iront propagation in deIibrillation.

Mathew TP, oore A, cIntyre , 09 , Randomised comparison oI electrode
positions Ior cardioversion oI atrial Iibrillation.

- Aston, Richard (1991). Principles oI Biomedical Instrumentation and
easurement: International dition.
- Trayanova N (2006). "DeIibrillation oI the heart: insights into mechanisms Irom
modeling studies.

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