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ASSISTING THE PATIENT UNDERGOING THORACENTESIS

Equipment
 Direct current defibrillator with paddles or multifunctional defibrillator pads.  Highly conductive multipurpose electrolyte gel.

PROCEDURE:
Sl. No Nursing Action Preparatory Phase Monitored Patient 1. If ventricular fibrillation is witnessed, precordial thump may be considered. 1 To minimize cerebral ischemia and potentially restart cardiac rhythm. CPR is essential before and after defibrillation to ensure blood supply to the cerebral and coronary arteries. Rationale

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Immediately implement cardiopulmonary 2 resuscitation (CPR) until defibrillator is available. Unmonitored patient

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Expose anterior chest and move jewelry and transdermal patches away from area.

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Jewelry may interfere with electrical current and cause serious burns.

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Immediately implement CPR until defibrillator is available. If response time is greater or equal to five minutes, perform two minutes of CPR prior to defibrillation.

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To provide oxygenated blood supply to the cerebral and coronary arteries.

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Apply multifunctional defibrillator pads or 3. paddles with conductive gel to patient's bare chest.

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Apply paddles or multifunctional pads.

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Multipurpose electrolyte gel provides better conduction than paddles alone. Do not allow gel to be spread across the chest because this may cause severe burns to the patient's chest and may divert the current from traveling to the heart. The paddles/pads are placed so that

Significantly lower energy levels are required with biphasic defibrillators. a. 5. insulated handles. give the command “ALL CLEAR. 6.” Look around quickly to make sure everyone is clear from the To prevent getting shocked. 6. The American Heart Association recommends that initial defibrillation should be 200 joules for biphasic or 360 joules for monophasic. b. he may get shocked when the patient is defibrillated. Biphasic is preferred over monophasic. b. 5. For paddles: a. the current directly traverses the heart. Anterolateral position: Apply one paddle/pad to just the right of the sternum below the clavicle and the other paddle/pad to just the left of the cardiac apex Anteroposterior position: Apply anterior pad over left apex and posterior pad under the infrascapular region. Grasp the paddles only by the a. Prevents danger of fire or explosion. Turn on defibrillator to the prescribed setting. If a person touches the bed.the electrical current flows through as much of the myocardium as possible. Once paddles b. Remove oxygen from immediate area. In this method. are charged. Means that the machine delivers current that flows in one direction for a specified duration then reverses the current to flow in the other direction. . 7. b. Charge the paddles.

antiarrhythmics are usually given to prevent recurrent episodes. For multifunctional pads: a. give the command “ALL CLEAR. the electrical current may take the path of least resistance and arc from one paddle to the other. 9. 2. 2. 9. Multifunctional pads provide handsfree defibrillation b. Push the discharge buttons located on both of the handles of the paddles while simultaneously exerting 25 lb of pressure to each of the paddles.patient and bed. 8. 8. After the patient is defibrillated and rhythm is restored. Press the charge button on thedefibrillator machine. If good skin contact is not maintained. c. Any resultant arrhythmia may require appropriate drug intervention. c.” Look around quickly tomake sure everyone is clear from thepatient and bed. Continue with intensive monitoring and care. . Follow-up Phase 1. Once the charge is reached. Push the shock button on the defibrillator machine. 1. The patient may remain in an unstable condition. To oxygenate the patient and restore circulation Resume CPR immediately after defibrillation.