Ehsan Abbasi
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Ehsan Abbasi ❑Defibrillator Definition
❑Defibrillator Function
❑Uses of Defibrillator
❑History of Defibrillator
❑Defibrillator Types
❑Defibrillator Operation
❑Operation of External Defibrillation
❑Operation of Internal Defibrillation
❑Operation of Synchronized Cardioversion
❑Defibrillator Use & Safety
❑Defibrillator Working Principles
❑Defibrillator System Diagram
❑Defibrillator Waveforms
❑Troubleshooting & Identifying Common Faults
❑Troubleshooting & Performance Checks
❑Daily User Inspection & Monitoring Log
❑Safety Considerations
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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.
Function :
▪ The heart is able to pump blood effectively only when contractions of all
its muscle fibres are precisely synchronized. In Ventricular Fibrillation
(VF), the normal rhythmic ventricular contractions are replaced by
rapid, irregular twitching that results in ineffective and severely reduced
pumping. If normal rhythm is not restored quickly, death is imminent.
▪ Getting the heart out of this situation is called Defibrillation. This can often
be achieved by applying an Electric Shock to the heart to depolarize the
myocardium and stop the uncoordinated contractions.
▪ The SA Node can then resume normal function, and sinus rhythm can be restored.
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Next to Ventricular Fibrillation (VF), also some other heart conditions, such as
rapid Ventricular Tachycardia (VT), can be corrected by a shock.
Uses of Defibrillator:
The earlier defibrillation occurs, the better the chances for survival.
For Every Minute that passes after the onset of VF, the chance of survival decreases by 10%.
The use of defibrillators is not restricted to hospitals. The portability Defibrillator/AEDs permits their use in any
location where patients are at risk of VF. This can include shopping centers, train stations, airport, etc.
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Ehsan Abbasi History of Defibrillator:
❑ First demonstrated on dogs in 1899 by Jean-Louis Prévost & Frederic Batelli, two physiologists
from University of Geneva, Switzerland.
❑ The first use on a human was in 1947 by Claude Beck, professor of surgery at Case Western
Reserve University.
❑ The first Czechoslovak "Universal Defibrillator Prema" was manufactured in 1957 by the
company Prema, designed by dr. Bohumil Peleška.
❑ Transthoracic defibrillation was first used in humans using alternating current (AC).
❑ Earlier in the 1980s, the "MU lab" at the University of Missouri had pioneered numerous studies
introducing a new waveform called a biphasic truncated waveform (BTE).
❑ Bernard Lown and his coworkers introduced direct current (DC) defibrillators into clinical practice.
❑ Mid 90s,Uniphasic replaced to Biphasic defibrillation alternates the direction of the pulses,
completing one cycle in approximately 12 milliseconds.
[Link] 05
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Defibrillator Types:
▪ Manual External Defibrillator
▪ Manual Internal Defibrillator
▪ Automated External Defibrillator
▪ Implantable Cardioverter-Defibrillator
▪ Wearable Cardioverter Defibrillator
▪ Internal Defibrillator
[Link]
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Ehsan Abbasi Defibrillator Operation:
Defibrillators typically have three basic modes of operation:
o External Defibrillation
o Internal Defibrillation
o Synchronized Cardioversion
▪ The electrical energy discharged to the
patient in each mode is provided by a large
capacitor that is charged over a period of
several seconds by rechargeable batteries or
by line power.
▪ An audible and/or visible indicator on the
defibrillator informs the operator when the
capacitor is charged and the device is ready
for discharge.
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For external defibrillation, the operator typically applies the paddles firmly to the
patient’s chest and discharges the defibrillator by simultaneously pressing two
discharge buttons (one button on each paddle).
The electrical discharge, which lasts less than 20 milliseconds, delivers a high-voltage
shock of approximately 2,000 to 4,000 Volts to the patient.
Gels, pastes, or disposable defibrillation pads are used to improve Conductivity
between the paddles and the chest. The paddle handles are well insulated to protect
the operator from shock.
Disposable defibrillation electrodes, which stick to the
patient’s skin and connect to the defibrillator through a
reusable cable, can be used as an alternative to paddles.
Paddle types used for external defibrillation include
standard adult (13 cm) and pediatric handheld paddles
which have typically 4.5 cm diameter
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For Internal Defibrillation in which the energy is
delivered directly to the exposed heart (e.g., during open-
heart surgery), all defibrillators are designed to limit the
maximum output energy to 50 Joules ( J) to prevent
injury to the heart muscle.
The paddles used for this purpose are smaller (about 50
mm in diameter), slightly concave, and designed to
withstand normal hospital sterilization.
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Synchronized cardioversion (sync mode) uses a defibrillator discharge to correct
certain arrhythmias, such as VT.
After verifying that the sync marker pulse (which indicates where on the ECG
waveform the defibrillator will discharge) appears reliably on the R wave, the
operator presses and holds the paddle discharge buttons; a shock
is delivered only when the control circuits sense the next R wave.
The delivery of energy is synchronized with and shortly
follows the peak of the R wave, preventing discharge
during the vulnerable period of ventricular repolarization,
which is represented by the T wave; defibrillation during
cardiac repolarization (T-wave) could cause the heart to
fibrillate.
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Ehsan Abbasi Defibrillator Use & Safety
▪ Sources of Oxygen must be removed from the patient during
defibrillation, because it supports combustion if arcing occurs.
▪ The paddles should Not Be Placed Near Metal Objects, either on
the surface of the skin (e.g. ECG leads or electrodes, skin clips,
jewellery)
▪ Staff Should Not Touch the bed, patient or any equipment
connected to the patient during defibrillation. Fluids may
conduct electricity, therefore it is important to ensure that
the immediate area is clean and dry.
▪ The defibrillator should not be charged until the paddles are applied to the
patient’s chest, because accidental discharge from open paddles may cause
injury or death. The operator must not touch any part of the paddle
electrodes.
▪ Before administering the charge, the operator must shout “Stand clear!”
and check that all staff have done so.
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Defibrillator Use & Safety
o Defibrillators compensate for impedance by delivering Larger Subsequent Shocks, adjusting the voltage used to
push the current through the chest, and adjusting the shock duration.
o If the defibrillator is charged but a shock is no longer
required, it should be Discharged through the
defibrillator internally by turning the control knob to zero
before removing the paddles from the patient’s chest:
charged paddles should never be returned to the
defibrillator. The defibrillator should never be
discharged with the paddles shorted together, as this
may cause burning and damage to the electrical
contacts.
o Equipment that does not have the ‘Defibrillator Protected’
symbol should be disconnected from the patient before
defibrillation to prevent damage, heating or arcing effects.
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Ehsan Abbasi Working Principles
❑ Fully Automated External Defibrillators
(AEDs) determine whether a defibrillating shock is
needed and automatically charge and discharge to
deliver a needed shock to the patient.
❑ Semi-Automated Units analyse the ECG and charge
in preparation for shock delivery, but the operator
activates the discharge.
❑ Automated and semi-automated AED units are
used within the hospital by first-responding
nurses or by police officers and firefighters
who respond to medical emergencies.
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Working Principles
▪ The most important component of a defibrillator is
a Capacitor that stores a large amount of energy
in the form of electrical charge, then releases it
over a short period of time.
▪ When the switch is in position 1, the capacitor is
charged. In position 2, the charge is released via the
paddles to the patient body.
▪ The inductor is needed to prolong the duration of
current flow.
▪ Successful defibrillation depends on delivery of the electrical charge to the myocardium. Only
part of the total current delivered (about 35 A) flows through the heart. The rest is dissipated
through the resistance of the skin and the rest of the body. The impedance of skin and thoracic
wall act as resistances in series, and the impedance of other intrathoracic structures act as
resistances in parallel with the myocardium. The total impedance is about 50–150 Ohms.
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Ehsan Abbasi Defibrillator System Diagram
[Link]
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Ehsan Abbasi Defibrillator Waveforms
Different Waveforms
(to send electrical current through
the patient’s heart) are used to
optimize the clinical success of the
defibrillation.
An external Bi-phasic defibrillator is
typically referred to as High-energy
Defibrillator if its waveform is
designed for use at energies ≤360 J and
a Low-energy Defibrillator if
designed for use at energies ≤200 J.
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❑ Failure to defibrillate a patient can be caused by
• Defibrillator Malfunction,
• Poor Electrode Application,
• Inappropriate Energy Selection,
• A Cardiac Physiologic State Not Conducive To Defibrillation.
Device problems are frequently related to problems with the Rechargeable Battery; therefore, careful
attention should be paid to Battery Maintenance. Nickel-cadmium (Ni-Cd) batteries should be periodically
deep discharged to help prevent premature battery failure. Nevertheless, whether used infrequently or
every day, Rechargeable Batteries have a limited life and Must Be Replaced Every One To Two Years.
The problems that commonly cause the defibrillator Not To Discharge are:
❖ Device is set in “SYNC” mode
❖ Only one discharge button is Depressed.
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Defibrillator Analysers Automate The Inspection
And Preventive Maintenance (IPM) Testing Of
Defibrillators.
They need to be able to test at least four basic
defibrillator performance characteristics:
▪ Discharge Energy
▪ Synchronized-mode Operation
▪ Automated External Defibrillation
▪ ECG Monitoring
✓ Defibrillator Analysers are used to perform Output Measurement Tests and Performance
Verification on defibrillator equipment. Mostly, these devices perform primary measurement of
Energy, Peak Voltage, Peak Current, Pulse Width, and Charge Time.
✓ Also, the device performs Cardioversion Analysis, Output Energy Measurement (in Joules), On-
demand Pacemaker Testing, and generates simulated performance waves used in defibrillator
testing as well as several additional tests.
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• Batteries Operation
• Output Power Verification
• Pacing Function
• Paddles Inspection
• ECG Leads
• Chassis for cracks
• Power and Paddle Cords (e.g. ensure no fissures, cuts, or broken wires)
• Date and Time of System
• Recorder Paper Installed Correctly
• Outdated supplies (e.g. gel pad electrodes)
• Knobs & Keypads
Most of the defibrillators provide an automated self-test function (Daily, Weekly, Monthly etc.).
Check in the User Manual !!
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Daily User Inspection & Monitoring Log
Ehsan Abbasi
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Ehsan Abbasi Safety Considerations
▪ One problem associated with defibrillation and cardioversion is SKIN
BURNS at the paddle or electrode sites. First- and second-degree burns
are especially likely to occur during Repeated Defibrillation attempts,
which require successively higher energies.
▪ Burns are usually caused by a high current flow through a small area (e.g.,
the edge of defibrillator paddles) and/or INCREASED RESISTANCE (e.g., Due
to Dried Gel).
▪ Paddles must be pressed firmly against the skin during defibrillation (25 lb of
force); when administering repeated shocks, users should check paddles for 25 lb.
adequate amounts of gel before each defibrillation attempt.
▪ When using disposable electrodes, users should check the expiration
date on the package and the integrity of the package (do not use if
the package has been opened).
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