Defibrillator

Supervisor: Dr. Mohamed Ali

BY: Jamal Khalid

JKh.13
 Definition
A device that reverses the Fibrillation of the heart.

•What is Fibrillation?
•Causes the heart to stop pumping blood.
•Leads to brain damage if untreated.

•How Defibrillation Works:

•An electronic device sends an electric shock to the heart.
•Stops an extremely rapid, irregular heartbeat.
•Restores normal heart rhythm.

•Purpose
•Treats life-threatening cardiac dysrhythmia.
•Effective against ventricular fibrillation and pulseless ventricular tachycardia.

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▪ High Voltage Current Application:
• Directly to the heart muscle
(Internal Defibrillator) through
the open chest.
Principle of Defibrillation
• Indirectly through the chest
wall (External Defibrillator).

▪ Purpose: To terminate Ventricular

Fibrillation.

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 Normal and Abnormal ECG Tracing

Normal ECG Tracing:

Displays a regular heart rhythm with distinct waves.

8/05/20XX CONFERENCE PRESENTATION 4

Normal and Abnormal ECG Tracing

•Abnormalities: •Abnormalities:
• Ventricular Fibrillation (VF): • Atrial Fibrillation (AF):
• A fast, irregular rhythm in the heart's • A fast, irregular rhythm in the upper
lower chambers (ventricles). heart chambers.
• The heart quivers and pumps little or • Characterized by the loss of the 'P'
no blood. waveform in the ECG.
• Consciousness is lost within • AF Treatment:
seconds. • Avoid delivering a shock during the
• If untreated, leads to sudden cardiac 'T' period to prevent ventricular
arrest. fibrillation.
• Achieved using the Synchronous
Mode.

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 Schematic Diagram of a Defibrillator
•Key Components and Functions:

• Variable Auto-Transformer (T1): Forms the primary of the system.

• High Voltage Transformer (T2): Steps up the voltage.
• Diode (D): Provides half-wave rectification of the transformer output.
• High Voltage Switch (Positions 1 and 2): Vacuum type, controls the charging and
discharging cycles.
• Oil-Filled Capacitor (16 µF): Stores energy for the shock.
• Current Limiting Inductor (L): Protects the patient by limiting current but dissipates some
energy due to resistance

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 Schematic Diagram of a Defibrillator
•Additional Components:
•Voltmeter (AC): Indicates the energy stored in the capacitor.
•Series Resistor (RS):
•Limits the charging current to protect the circuit.
•Determines the time for full charge on the capacitor (T = RC).
•Discharge Resistor (R): Represents the patient's resistance (50–100 Ω).
•Operation Cycle:
[Link] 1:
•Capacitor charges to ~4000 V, set by the auto-transformer.
[Link] 2:
•Foot switch or push button activates the discharge cycle.
•Capacitor discharges across the heart through electrodes.

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•Key Components:
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• Inductor

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Power Supply/Voltage Source

•Step-Up Transformers:
• Increase voltage for the defibrillator.
• Allow doctors to choose the amount of charge.
•Process:
• Output voltage is fed to the capacitor to store the charge.
• Internal Rechargeable Batteries: Provide an additional energy source.
•Conversion:
• AC to DC: Step-up transformers convert 240 VAC to 5000 VAC.
• Rectification: Output is converted to DC by a rectifier.
• Battery Mode: DC is converted to AC by an inverter, amplified, and then rectified to DC.

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Capacitors and Inductors

•Capacitors :
• Store energy in the form of electric charge.
• Release energy rapidly during discharge.
• Capacitance Formula: C=QVC = \frac{Q}{V}C=VQ
• Capacitance Factors:
• Proportional to the area of plates.
• Inversely proportional to the distance between plates.
•Inductors :
• Coils of wire that create a magnetic field when current flows.
• Used to prolong the duration of current flow.
• Inductance: The property that opposes changes in current.

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Operating Principle of Defibrillators

•Types of Defibrillators:
• Monophasic Defibrillator
• Bi-Phasic Defibrillator

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 Monophasic Defibrillator

•Current Delivery:

• Delivers current in one forward direction

(positive).
•Energy Requirements:

• Requires higher escalating energy levels (200–

300 J).
• Used to convert VF (Ventricular Fibrillation) or
pulseless VT (Ventricular Tachycardia).

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Bi-Phasic Defibrillator
•Bi-Phasic Waveform:

• Delivers energy through the chest in two directions.

• Reverses the direction of electrical energy near the midpoint
of the waveform.
•Energy Efficiency:

• Low-energy biphasic shocks may be as effective as higher-

energy monophasic shocks.
•Applications:

• Commonly used in Implantable Cardioverter-Defibrillators

(ICDs) and Automated External Defibrillators (AEDs).

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•Types of Electrodes:

• Spoon-Shaped Electrode:

• Applied directly to the heart.

• Paddle-Type Electrode: Defibrillator Electrodes
• Applied against the chest wall.
• Pad-Type Electrode:

• Applied directly on the chest

wall.

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 External Defibrillation Electrodes

Electrode
Design Features:
Characteristics:

• Metal discs (3–5 • Larger size to handle • Electrodes contain

cm in diameter) or high current for safety switches.
external defibrillation. • Capacitor discharges
rectangular flat •Prevents burns under only when electrodes
paddles (5x10 the electrodes by have firm contact with
cm). distributing energy. the patient's chest.
• Attached to highly •Electrode size
insulated handles. influences chest wall
impedance, affecting
defibrillation efficiency

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Internal Defibrillation Electrodes

Internal Defibrillation:
• Used when the chest is
open.
• Large spoon-shaped
electrodes are applied
directly to the heart.

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Paddle Placement
Two Methods of Placement (AHA
Recommendations):

Anterior-Anterior:

• Place one paddle near the second or third right sternal

border.
• The other paddle on the cardiac apex.

Anterior-Posterior:

• One paddle on the sternum and the other on the left infra-
scapular region.

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 Important Factors in Defibrillation
Time: Energy Level (AHA
Recommendations):
Paddle Size: Skin to Paddle Interface:

Adults: Adults: 8–13 cm in diameter

Correct gel amount prevents
Early defibrillation burns or arcing.
• First shock: 200 J
increases success. Children: 4.5 cm in diameter
Check expiration date for
• Second shock: 200- disposable paddles.
300 J
CPR: Early initiation Infants: Use Anterior-Posterior
• Third and above: 360 placement
improves success.
J
>8 mins: Paediatrics:
Neurological damage • First shock: 2 J/kg
begins. • Subsequent shocks:
>10 mins: Survival Double the energy.
probability drops Defibrillation for
significantly. VF and Pulseless
VT:
• Monophasic: 360 J
• Biphasic: 120-200 J 18
 Types

Manual • Requires clinical expertise to interpret heart rhythm.

• Energy selection and shock delivery are manually
Defibrillator: controlled.

• Small, safe, simple, and lightweight with two pads for application.
Automatic • Guides the user through a step-by-step protocol.
Defibrillator: • Analyzes rhythm and provides voice prompts and display
instructions for shock delivery.

External • Delivers high-energy shock externally on the chest using a

defibrillator paddle.
Defibrillator: • Energy levels: 360 J (Monophasic), 200 J (Biphasic).

Internal • Delivers shock directly to the heart using a sterilized

Defibrillator: internal handle/paddle.

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 Types

• Fully Automatic: Analyzes ECG rhythm, decides if shock is

AED (Automatic External needed, and automatically charges and discharges.
Defibrillator): • Semi-Automatic: Analyzes ECG, notifies the operator to
deliver the shock, and the operator activates the discharge

• Detects fast heart rhythms and either paces or

ICD (Implantable Cardioverter shocks the heart to restore normal rhythm.
Defibrillator):
• Shocks are felt as a strong jolt.

• Electronic device that provides periodic electrical

stimulation to the heart.
Pacemaker: • Types:
• Internal Pacemaker
• External Pacemaker
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Normal and Abnormal ECG Tracing

• Purpose:
Timing the shock to the R wave of the ECG ensures it is delivered during a safe period.
• Why it's important:
• Prevents delivering the shock during the vulnerable (relative refractory) period of the
cardiac cycle.
• Avoids inducing ventricular fibrillation.

CONFERENCE PRESENTATION 21
 Defibrillator Maintenance

•Damage Reports:
• Follow manufacturer’s maintenance checks.
• Report any discrepancies, defects, or damaged parts immediately to the Early
Defibrillation Program Coordinator.
•Calibration & Self-Testing:
• No calibration or energy delivery verification required.
• Regular self-tests ensure the device is ready for use.
•Suggested Maintenance Schedule:
• Refer to the device's Instructions for Use for maintenance tasks and schedules.
•Cleaning:
• Clean using recommended cleaning agents as per the manufacturer’s instructions.

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Thank you
Jkh.13

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