Name of Presenter:- Edward Jesubel

Designation:-Nurse Educator
DEFIBRILLATOR
 HEART
 Heart is an organ that pumps blood throughout the body so that there is blood supply to every cell
in our body.

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CIRCULATION OF BLOOD IN HEART

Superior

rta
vena cava

ry
Pulmonary Vein

Ao

te
ar
ry
Lft. Atrium

a
on
lm
Rt. Atrium

Pu
Lft. Ventricle
Inferior
vena cava

Rt. Ventricle
 CONDUCTION SYSTEM
For each heartbeat , electrical signals travel through the conduction pathway of the heart

It starts when the sinoatrial (SA) node creates an excitation signal

The excitation signal travels to the atria (top heart chambers), making them to contract

The signal is then passed to the atrioventricular (AV) node

The bundle of His carries the signal to the Purkinje fibers

The Purkinje fibers to the ventricles (bottom heart chambers), causing them to contract.

The electrical signals that travel through the heart conduction system cause the heart
to expand and contract
These contractions control how blood flows through the heart(60-90 beats of contractions of heart
in a minute)
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CONDUCTION SYSTEM
 Normal pumping of the heart takes place with the help
of normal conduction system.

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Normal conduction leads to a normal sinus rhythm = Normal heart rate : 60-90 beats per min

When the normal transmission of the cardiac impulse through the heart’s electrical conduction system is
interrupted it gives rise to irregular heart beat=ARRHYTHMIAS.

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 Normal sinus rhythm

Bradycardia Tachycardia
BRADY-ARRYTHMIAS TACHY-ARRYTHMIAS

1. Sinus Bradycardia 1. Atrial Fibrillation

2. Sick sinus syndrome 2. Supra ventricular tachycardia

3. Ventricular Fibrillation

4. Ventricular tachycardia

5.Premature ventricular contractions

6. Atrial Flutter
VENTRICULAR FIBRILLATION

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VENTRICULAR FIBFRILLATION

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VENTRICULLAR FIBFRILLATION
Lower chambers of the heart
quivers/twitches

Low cardiac output

Insufficient pumping of blood to all

organs

Sudden cardiac arrest

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What do you do when a person has a cardiac
arrest/ loses consciousness?
CARDIAC ARREST
 Absence of pulse

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RESPIRATORY ARREST
 Absence of Breathing

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 CODE BLUE
 It is a hospital wide alert, done when a patient
is experiencing a Cardiac or a respiratory
arrest

 All the staff members near the location of the

code, may need to go to the patient, who
requires immediate resuscitation and is handled
by a code team of the hospital

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 RESPONSE DURING CODE
BLUE EVENT

ONE TWO
RESCUER RESCUERS

1. Begin CPR immediately and 2. Calls for help or

With no mobile phone, leave
sends someone to call for help gets an AED
the victim and get the AED
and get the AED to use it soon
before beginning CPR.
as it is available.
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WHO DOES A CODE BLUE TEAM COMPRISE OF?
Differs from hospital to hospital

 The First Responder at the site of the event is the patient's own nurse
 The Team Leader (critical care doctor)
 Another Doctor
 Anesthesiologists
 Critical care nurse with ACLS certification
 The Recorder (ACLS certified)
 The Medication Nurse (ACLS)
 The Respiratory Therapist
 The Runner (any member of healthcare team, even a technician
 Other Team Members
. Two members to give CPR
. Code cart In-charge nurse (to read ECG,

run the defibrillator)

 WHY SHOULD BLS AND ACLS BE GIVEN?
 Brain death occurs within 4-6 mins without circulation

BASIC LIFE SUPPORT

ADVANCED CARDIAC
LIFE SUPPORT

 BLS is started within 4mins and rapid ACLS within 8 mins to establish neurological recovery and survival.

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 •CPR:- Cardio-Pulmonary
BASIC LIFE SUPPORT
Resuscitation

ADVANCED 1.Addition to BLS

2. Use of adjunctive equipment and techniques
CARDIAC 3. ECG monitoring
LIFE 4. Defibrillation
SUPPORT 5. IV access and pharmacological therapy
 BASIC LIFE SUPPORT
Cardio Pulmonary Resuscitation: MANUAL CHEST COMPRESSIONS + ARTIFICIAL VENTILATION

COMPRESSION
(push hard and fast on the chest)

AIRWAY
(head back and chin lift)

BREATHING
(rescue breaths)

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COMPLETE CHEST RECOIL COMPLETE CHEST RISE
• Important note:
Rescuers should Rescuers should not

 Chest compressions at a rate 100-120/min  Compress at a rate slower than 100/min or faster
than 120/min

 Compress to a depth of atleast 2inches(5cm)  Compress at a depth of less than 2inches(5cm)or

greater than 2.4inches(6cm)

 Interrupt compressions for greater than 10

 Minimize pauses in compressions
seconds

 Ventilate adequately(2breaths after 30  Provide excessive ventilation (ie.too many

compressions breaths or breaths with excessive force)

 Allow complete chest recoil

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 BASIC LIFE SUPPORT

Final Vids - OneDrive (sharepoint.com)

PULSE BREATHING

Monitor the patient

(identify the cause of
unresponsiveness)
Or send someone to do so

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WHEN TO STOP CPR

• Stop CPR after 20 minutes if there is no ROSC or viable cardiac

rhythm re-established

• Signs of life appear

• Unsafe scene 

• Exhaustion of the rescuer/compressor. 

• Care transferred to medical services or to a properly trained

personnel 

• Death is recognized 
 ACLS

 Use of adjunctive equipment and techniques

 ECG monitoring
 Defibrillation
 IV access and pharmacological therapy
 Addition to BLS

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SHOCKABLE RHYTHM(V-Fib/Pulseless VT) NON-SHOCKABLE RHYTHM(ASYSTOLE/PEA)

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 SHOCKABLE RHYTHM NON-SHOCKABLE RHYTHM

VENTRICULAR FIBRILLATION ASYSTOLE

PULSELESS VENTRICULAR TACHYCARDIA PULSELESS ELECTRICAL ACTIVITY

 Defibrillatio
n
 Process in which an electronic de-
vice(defibrillator) gives high energy electric shock
to the heart’s muscle fibers to contract normally
and give rise to normal physiological pace making
Defibrillation Explainer Vide
pulses.
o 4k Resolution Stock Footag
e Video (100% Royalty-free)
1068275774 | Shutterstock
 Role of Defibrillator:-
 Enables the hearts natural pace maker to
regain control and establish a normal heart
rhythm and helps to resume normal heart
functioning.

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 CONTRAINDICATIONS OF
INDICATIONS OF DEFIB
DEFIB
Ventricular Fibrillation

VT in the absence of a pulse(Pulseless V-tach). 

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TYPES OF DEFIBRILLATOR SHOCK
TYPES OF DEFIBRILLATORS 

Manual internal defibrillator Wearable cardiac defibrillator

Implantable cardioverter defibrillator

Automated external defibrillator

Manual external defibrillator

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 MANUAL INTERNAL DEFIBRILLATOR
 These are the direct descendants of the work of Beck and Lown.
 They are virtually identical to the external version, except that the charge is delivered through internal
paddles in direct contact with the heart.
 These are extremely found in operating theatres where the chest is likely to be open or can be opened
quickly by a surgeon

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 WEARABLE DEFIBRILLATOR

WCD is indicated for people who are at risk of:

 Sudden cardiac arrest (SCA) following a heart attack,

 Before or after bypass surgery

 Stent placement

 Cardiomyopathy

 Congestive heart failure

 IMPLANTABLE CARDIOVETER DEFIBRILLATOR

ICDs are implanted in patients who are at high

risk for sudden cardiac arrest (SCA) due to
sustained ventricular tachycardia or fibrillation.
These devices are used to improve the heart’s
pumping ability in heart failure patients

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 Automated External Defibrillator 

• (AED) is a portable electronic device that

automatically diagnoses the life-threatening
cardiac arrhythmias of ventricular fibrillation
(VF) and pulseless ventricular tachycardia, and
is able to treat by delivering shock through a
portable defibrillator.  
 Functioning 

1.Connect the electrodes(pads) to the patient’s upper right side

 below the collar bone and on left side below the armpit 
2. Avoid touching the patient to avoid false readings by the unit ICDs which are
implanted
3.The AED examines the electrical output from the heart and
determines the patient is in a shockable rhythm or not. 

4.When device determined that shock is warranted. it will change its internal capacitor in preparation to
deliver the shock. 
5.When charged, the device instructs the user to ensure no one is touching the victim and press a red
button to deliver the shock. 
6.Thus shock is delivered 
 
Defibrillator electrode placement

• Adhesive patches are superior due to their ability to

provide appropriate EKG tracing without the artefact
visible from human interference with the paddles.

• Adhesive electrodes are also inherently safer than the

paddles for the operator of the defibrillator to use,as they
minimize the risk of the operator coming into
physical(and thus electrical) contact with the patient as
the  shock  is delivered, by allowing the operator to stand
several feet away. 

• Another inconvenience of the paddle is the requirement

of around 25lbs of pressure to be applied while
defibrillating. 
Manual External Defibrillator
PARTS OF DEFIBRILLATOR AND HOW TO RUN
AN OPERATIONAL CHECK OF DEFIBRILLATOR

Final Vids - OneDrive (sharepoint.com)

 Apply gel on the  Place the cardiac One paddle is placed along the
defibrillator monitor/defibrillator in upper right sternal border and the
paddles the defibrillation mode other placed at the cardiac apex

Press the "shock" button Check the scene The defibrillator’s

capacitor is charged

The shock is delivered CPR is immediately resumed for 2minutes(5cycles)

If VF or pulseless VT persists second shock is Palpate pulse and check the

given electrical rhythm on the monitor

If VF or pulseless VT persists at the next pulse and

CPR is immediately resumed for 2 minutes, after
the second shock.
VF/pulseless VT, 1mg of epinephrine to be administered
IV every 3-5mins during the resuscitation after the first
unsuccessful defibrillation
rhythm check, 300 mg of amiodarone to be
administered as a bolus intravenously during the
resuscitation.
If additional doses of anti-arrhythmic drugs are
needed ,150mg amiodarone can be given/1-1.5mg/kg
lidocaine can be administered
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 PROCEDURE

Final Vids - OneDrive (sharepoint.com)

 SHOCKABLE (pulseless VT/V-Fib) 
 

1st shock (150-200 J biphasic, 360 J monophasic)  5th shock 

CPR 30:2 (2 min)

Check monitor (If VF,VT persist) 
Further shock after each 2 min period of CPR  
2nd Shock (150-360 biphasic,360 monophasic) 

CPR 30:2 (2 min)

Check rhythm (If VF,VT persist) 
Adrenaline 1mg IV every 3-5 min  If organized electrical activity seen, check for pulse   

3rd shock 
If no pulse and asystole If pulse present: start post
CPR 30:2 (2 min)
seen: continue CPR and resuscitation care 
Check monitor (if VT,VF persists)
switch on to non
Amiodarone (300 mg IV) 
shockable rhythm 
 
CPR 30:2 (2 min)
4th shock 
2ND dose of Adrenaline 1mg IV 
 POST RESUSCITATION CARE

Check the site of Maintain oxygen

paddle application saturation of >94 Prevent hypothermia 
for any burns or equal to it 

 Perform a ECG
 Check acid base
on patient after the
balance  
procedure 

Position the client and

keep in close
observation for next few
hours if stabilized. 

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 COMPLICATIONS

If an electrical shock were to be administered to

someone who is not in VF or pulseless VT, it is possible
to induce VF by the “R-on-T phenomenon" which would
result in a patient who originally had a pulse being put
into cardiac arrest. For this reason, defibrillation is only
performed for VF or pulseless VT. 
 

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PULSE BREATHING

Monitor the patient

(identify the cause of
unresponsiveness)
 ALONE WITH THE ALONE WITH A TWO STAFF AT THE
PATIENT WITH A PATIENT WITH A SCENE OF CARDIAC
CARDIAC ARREST RESPIRATORY ARREST ARREST

1. Begin CPR immediately and

With no mobile phone, With no mobile phone,
sends someone to call for help
leave the victim and get leave the victim and get
and get the AED to use it soon
the AED before beginning the AED before starting
as it is available.
CPR. rescue breaths.
2. 2. Calls for help or gets an AED