DEFIBRILLATION • Junctional ectopic tachycardia (JET)  Electrocution of the by-standers

DEFIBRILLATION • The patient has a valid do-not-resuscitate order (DNR)  Formation of short circuits between paddles due to excessive amount of conduction jelly applied on the
- electrical current administered to stop a dysrhythmia. It is used in emergency situations as the treatment of • The patient is wet and lying in water (outside hospital setting) paddles. This causes loss of electrical energy.
choice for ventricular fibrillation and pulseless VT. • Multifocal atrial tachycardia  Dysrhythmias Pulmonary edema
DEFIBRILLATOR • Presence of a pulse  Cardiac arrest Pulmonary or systemic emboli
– are devices that restore a normal heartbeat by sending an electric pulse or shock to the heart. They are used to • Obvious signs of death  Respiratory arrest Equipment malfunction
prevent or correct an arrhythmia, a heartbeat that is uneven or that is too slow or too fast. Defibrillators can also FACTORS AFFECTING DEFIBRILLATION ANALYSIS  Neurologic impairment Death
restore the heart's beating if the heart suddenly stops.  Electrode position  Altered skin integrity
CARDIAC ARREST  Hand-held versus patch electrodes
– a sudden loss of blood flow resulting from the failure of the heart to pump effectively. Signs include loss of  Electrode position PARTS OF DEFIBRILLATOR
consciousness and abnormal or absent breathing. Some individuals may experience chest pain, shortness of breath,  Electrode pad size
or nausea before cardiac arrest.  Automated rhythm analysis
VENTRICULAR FIBRILLATION  Device maintenance and quality assurance
- is a rapid but disorganized ventricular rhythm that causes ineffective quivering of the ventricles. There is no atrial CAUTION AND REMINDERS IN OPERATIBNG DEFIBRILLATION
activity seen on the ECG.  Maintain good contact between the pads or paddles (with a conductive medium) and the patient’s skin to
RESPIRATORY ARREST prevent electrical current from leaking into the air (arcing) when the defibrillator is discharged
- cessation of breathing. Respiratory arrest is usually the endpoint of respiratory distress that leads to respiratory  The defibrillator is discharged. Ensure that no one is in contact with the patient or with anything that is
failure touching the patient when the defibrillator is discharged, to minimize the chance that electrical current will be
HEART conducted to anyone other than the patient.
- is a muscular organ about the size of a fist, located just behind and slightly left of the breastbone. The heart pumps  Place paddles or pads so that they do not touch the patient’s clothing or bed linen and are not near
blood through the network of arteries and veins called the cardiovascular system. medication patches or direct oxygen flow.
CARDIOVASCULAR COLLAPSE  If cardioverting, ensure that the monitor leads are attached to the patient and that the defibrillator is in sync
- Sudden loss of effective blood flow due to cardiac and/or peripheral vascular factors that may reverse mode. Ifdefibrillating, ensure that the defibrillator is not in sync mode (most machines default to the “not-sync”
spontaneously. mode). Basic Parts of Defibrillator
VENTRICULAR TACHYCARDIA  Use multifunction conductor pads or paddles with a conducting agent between the paddles and the skin (the
- is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute. The causes are conducting agent is available as a sheet, gel, or paste).
similar to those for PVC. VT is usually associated with coronary artery disease and may precede ventricular  Do not charge the device until ready to shock; then keep thumbs and fingers off the discharge buttons until
fibrillation. VT is an emergency because the patient is usually (although not always) unresponsive and pulseless. paddles or pads are on the chest and ready to deliver the electrical charge.
PURPOSE OF DEFIBRILLATION  Exert 20 to 25 pounds of pressure on the paddles to ensure good skin contact.
 To treat a tachycardia (atrial or ventricular)  Before pressing the discharge button, call “Clear!” three times: As “Clear” is called the first time, ensure that

 To disrupt a chaotic rhythm and allow the heart's normal pacemakers to resume effective electrical activity you are not touching the patient, bed or equipment; as “Clear” is called the second time, ensure that no one

 It reverses the cardiac arrest by sending an electrical current through the heart muscle cells, momentarily is touching the bed, the patient, or equipment, including the endotracheal tube or adjuncts; and as “Clear” is

stopping the abnormal electrical energy and allowing the normal heart beat to resume called the third time, per-form a final visual check to ensure you and everyone else are clear of the patient

 Treatments for tachydysrhythmias and anything touching the patient.

INDICATIONS
 Record the delivered energy and the results (cardiac rhythm,

• Patient who has tachydysrhythmias pulse).

• Ventricular tachycardia or pulseless VT

 After the event is complete, inspect the skin under the pads or paddles for burns; if any are detected, consult

• Ventricular fibrillation with the physician or a wound care nurse about treatment.

• Atrial fibrillation TYPES OF DEFIBRILLATORS

• Atrial flutter
COMPLICATIONS 1. MANUAL EXTERNAL DEFIBRILLATOR
CONTRAINDICATIONS
 Damage to myocardium due to repeated high energy electrical shocks
An advanced life support medical device that monitors the heart rhythm and allow the user to manually set
• Digitalis induced dysrhythmias
 Chest burns due to repeated high-energy discharges and poor contract between the paddles and the skin
the energy delivery and deliver a shock.
 2. MANUAL INTERNAL DEFIBRILLATOR 14. Continue resuscitative efforts until patient regains pulse or until physician determines death.
Deliver the shock through paddles placed directly on the heart. They are mostly used in the operating room
and, in rare circumstances, in the emergency room during an open heart procedure.

3. SEMI-AUTOMATED EXTERNAL DEFIBRILLATOR

Used by lay responders to treat someone in cardiac arrest. The user pushes. the on button, pulls a handle or
opens the lid and the AED starts to talk to you. The user will open the pads and place them on the patient as
indicated by pictures on the pads.
4. AUTOMATED EXTERNAL DEFIBRILLATOR (AED)
AEDs are considered a public access device designed to be used by anyone, whether they are trained or
not. The device walks the user through the rescue until EMS arrives or the person is revived.
5. IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (ICD)
A device implantable inside the body, able to perform cardioversion, defibrillation, and pacing of the heart.
The device is therefore capable of correcting most life-threatening cardiac arrhythmias.
6. WEARABLE CARDIAC DEFIBRILLATOR
A device worn by patients who are at risk for sudden cardiac arrest. A WCD allows physicians time to assess
for their patient's arrhythmic risk and make appropriate plans. A WCD is lightweight and easy to wear.
STEPS AND GUIDELINES IN OPERATING DEFIBRILLATOR
 STEPS
1. Establish unresponsiveness and call for help.
2. Establish absence of respirations and lack of circulation: no pulse, no respirations, no movement.
3. Activate code team in accordance with hospital policy and procedure.
4. Start chest compressions and continue until defibrillator is attached to patient and verbal prompt of device
advises you, “Do not touch the patient.
5. Place defibrillator next to patient near chest or head.
6. Turn on power
7. Attach device. Place the first pad on the upper right sternal border directly below the clavicle. Place the second pad
lateral to the left nipple with the top of the pad a few inches below the axilla. Ensure that cables are connected to the
machine.
8. When defibrillator prompts you, stop touching patient. Do NOT touch patient after this prompt. Direct rescuers or medical
professionals to avoid touching patient by announcing “Clear!” Allow the defibrillator machine to analyze the rhythm. Some
devices require that an analysis button be pressed. The defibrillator takes approximately 5 to 15 seconds to analyze the
rhythm.
9. Before pressing the shock button, announce loudly to clear the victim and perform a visual check to ensure that no one is
in contact with victim.
10. Immediately begin chest compression (CPR) after the shock and continue for 2 minutes.
11. Deliver two breaths using mouth-to-mouth with barrier device or mouth-to mask device or bag-mask device. Watch for
chest rise and fall. Deliver 10 to 12 breaths/min.
12. After 2 minutes of CPR, the defibrillator will prompt you not to touch patient and will resume analysis of patient’s rhythm.
This cycle will continue until patient regains a pulse or physician determines death.
13. Inspect pad adhesion to chest wall. If pads are not in good contact with chest wall, remove them and apply a new set.
Attach new set of pads to the defibrillator.