Defibrillation
Defibrillation is a process in which an electronic device sends an electric
shock to the heart to step an extremely rapid, irregular heart beat and
restore the normal heart rhythm
INDICATIONS
Ventricular fibrillation
Atrial Flutter
Wide QRS Complex
Purposes
• Defibrillation is performed to correct the life threatening fibrillation of
the heart , which could result in cardiac arrest .
• It should be performed immediately after identifying that the patient
is experiencing a cardiac emergency has no pulse and is unresponsive
Principles of defibrillation
1. Energy storage capacitor is charged at relatively slow rate from AC line
2. Energy stored in capacitor is then delivered at a relatively rapid rate to
chest of the patient.
3. Simple arrangement involve the discharge of capacitor energy
through patients own resistance
4. The discharge resistance which the patient represents as purely
resistance of 50 to 100 ohms
5. This particular waveform figure is called as “Lown” waveform
6. The pulse width of this waveform is generally 10ms.
Cardioversion
Indications
Pulse is present
• Supraventricular tachycardia
• Atrial fibrillation
• Atrial flutter
• Ventricular tachycardia
Difference between defibrillation and
cardioversion
Parts of the Defibrillator
Waveform
• Monophasic waveform
• Biphasic wave form
Positions of paddles / pad on the chest
1. Standard / anterolateral
2. Anterio posterior
Procedure for Defibrillation
1. Identify the rhythm
2. Assess the responsiveness
3. Assess the clients airway , breathing and circulation
4. Begin CPR until defibrillation is ready
5. Position the patient supine
6. Remove the transdermal NTG patches from the patients chest and
back if using anterior – posterior placements.
7. Remove the metallic objects that may be wearing
8. Turn on the defibrillator
9. Turn off the synchronizer mode
10. Set the energy level at 200joules
11. Lubricate the paddles to enhance the conduction and prevent skin
burn
12. Position the paddles on the chest
13. Press the paddles firmly against the patients chest on correct
position
14. Connect the monitoring leads of the patients chest on correct
position
15. Turn the ECG recorder to provide a visual recording of the patients
ECG as well as in response to intervention
16. Charge the paddles by pressing the charge buttons , located either
on the defibrillator
17. Reassess the patient rhythm
18. Instruct all personnel to stand clear off the patient and patient bed
before discharging the current saying I clear , You clear , And we all
clear .
• Discharge the current by pressing both the charge buttons
simultaneously maintain 11kg of pressure on both the paddles .
• Hold until the defibrillator delivers the electrical current
• Reassess the rhythm if VT persists shock the second time at
200 J -300J
• Repeat the assessment necessary increase the energy to 360J.
Post procedure care
• Reassess the patients cardiac rhythm
• If defibrillation restores pulses and obtain a blood pressure reading
and heart rate
• Assess the patients respiratory status , level of consciousness, ,
cardiac rhythm, breath sounds , skin color and urine output.
• obtain baseline ABG levels and 12 lead ECG.
• Provide supplemental oxygen and ventilation.
• Check the patient for electrical burns
• Prepare the defibrillator for immediate re-use .
Special considerations
• Do not place the paddles over the female breast . Instead place the
apex of the paddle at the fifth to sixth intercostal space , with middle
of the paddle at the mid axillary line.
Complications
• Damage to myocardium due to repeated high energy electrical
shocks.
• Chest burns due to repeated high energy discharges
• Electrocution to the by standards
• Formation of short circuits between paddles due to excessive amount
of conduction jelly applied on the paddles.
NURSING RESPONSIBILITY
Scenario
A 30 years old female was brought to emergency room after collapsing
in a swimming pool. The swimming instructors had lifted her out within
1-2 min after the collapse. Since the female had no pulse, the
instructors had performed CPR. In the emergency the ECG shows that
patient had ventricular fibrillation.
