Medical equipment 02

LECTURE 7:
Defibrillator & Pacemaker
 Defibrillator & Pacemaker
Outline:
• Defibrillation Definition
• Need of defibrillation
• The principle and mechanism of defibrillation
• Types and classes of defibrillator
• The automated external defibrillator (AED)
• The risk and safety procedures
• Troubleshooting of defibrillator
Remember this..?
 Defibrillation Definition
• Defibrillation is a process in which an electronic
device sends an electric shock to the heart to
stop an extremely rapid, irregular heartbeat,
and restore the normal heart rhythm.
• Defibrillation is a common treatment for
ventricular fibrillation, and pulse less
ventricular tachycardia.
• When there is no recognizable rhythm in the
heart, it is ventricular fibrillation.
 Need of Defibrillation
• Ventricular fibrillation is a serious cardiac emergency resulting
from asynchronous contraction of the heart muscles.
• Due to ventricular fibrillation, there is an irregular rapid heart
rhythm.
 Principle of Defibrillation..
• Energy storage capacitor at relatively slow rate from AC line.
• Energy stored in capacitor is then delivered at a relatively rapid rate to chest of the patient.
• Simple arrangement involve the discharge of capacitor energy through the patient’s own
resistance.
• The discharge resistance which the patient represents as purely ohmic resistance of 50 to 100 Ω
approximately for a typical electrode size of 80cm2.
• The pulse width of this waveform is generally 10ms
 Principle of Defibrillation
• Operator selects energy delivered:
50-360 joules, depends on:
- Essential characteristics of patient
- Patient’s disease
- Duration of arrhythmia
- Patient’s age
- Type of arrhythmia (more energy
required for ventricular fibrillation)
 Mechanism of Defibrillation
• Fibrillation cause the heart to stop pumping blood,
leading to brain damage.
• Defibrillations deliver a brief electric shock to the heart,
which enables the heart’s natural pacemaker to regain
control and establish a normal heart rhythm.
 Defibrillator Electrodes..
• Types of defibrillator
electrodes:
• A) Spoon shaped electrode
• Applied directly to the
heart.
• B) Paddle type electrode
• Applied against the chest
wall
• C) Pad type electrode
• Applied directly on chest
wall
Defibrillator Electrodes
Classes of Discharge Waveform
 Classes of Discharge Waveform
• There are two general classes of waveforms:
• A) mono-phasic waveform
• Energy delivered in one direction through the patient’s heart.
• B) biphasic waveform
• Energy delivered in both direction through the patient’s heart.
• The biphasic waveform is preferred over
• Monophasic waveform to defibrillate. Why??
 A monophasic type, give a high energy shock,
o Up to 360 to 400 joules due to which increased Cardiac injury
and in burns the chest around the Shock pad sites.
 A biphasic type, give two sequential lower Energy shocks of 120-
200 joules, with each Shock moving in an opposite polarity
between the pads
 Types of Defibrillators
A) Internal defibrillator
Electrodes placed directly to the heart
E.g. Pacemaker
B) External defibrillator
Electrodes placed directly on the heart
E.g. The Automated external defibrillator (AED)
 External defibrillator
• For each minute passing between start of ventricular
fibrillation and first defibrillation, survival decreases by
10%
• Defibrillators should be portable, battery operated, small
size.
• Energy in defibrillators usually stored in large capacitors.
• Total energy stored in capacitor:
Vc: capacitor voltage
 External defibrillator

Applies shock about 20ms after QRS complex, avoids T- wave

Automated External Defibrillator (AED)
 AED is a portable electronic device that automatically
diagnoses the ventricular fibrillation in a patient.
 Automatic refers to the ability to automatically analyses
the patient’s condition.
 AED is a type of external defibrillation process.
 AEDs require self- adhesive electrodes instead of hand
held paddles.
 The AED uses voice prompts, lights and text messages to
tell the rescuer what steps have to take next.
 Troubleshooting of Defibrillator
 Attach the external and internal paddles if the monitor
reads, “No paddles”
 Check to ensure that the leads are securely attached if the
monitor reads, “No leads”
 Connect the unit to AC power if the message reads, “Low
battery”
 Verify that the Energy Select control settings are correct if
the defibrillator does not charge.
 Change the electrodes and make sure that the electrodes
adapter cable is properly connected if you receive a
message of “PACER FAILURE” Restart the pacer.
 Close the recorder door and the paper roll if the monitor
message reads, “Check recorder”