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Understanding Defibrillators: Types & Usage

The document explains the function and types of defibrillators, detailing how they work to restore normal heart rhythm by depolarizing heart muscle cells. It outlines indications for use, such as ventricular fibrillation and pulseless ventricular tachycardia, and emphasizes the importance of proper electrode placement and energy selection for effective defibrillation. Additionally, it covers troubleshooting, aftercare, and the use of Automated External Defibrillators (AEDs) for both adults and pediatric patients.

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tanya
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17 views39 pages

Understanding Defibrillators: Types & Usage

The document explains the function and types of defibrillators, detailing how they work to restore normal heart rhythm by depolarizing heart muscle cells. It outlines indications for use, such as ventricular fibrillation and pulseless ventricular tachycardia, and emphasizes the importance of proper electrode placement and energy selection for effective defibrillation. Additionally, it covers troubleshooting, aftercare, and the use of Automated External Defibrillators (AEDs) for both adults and pediatric patients.

Uploaded by

tanya
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

DEFIBRILLATOR

How does defibrillator work?

• Conducting system of heart possess several


pacemakers – Sinoatrial (SA) node, Atria,
Atrioventricular (AV) node, Ventricles.
• Sometimes, an event causes different pace maker
cells to start firing out of sequence. As a result, the
heart will start to contract in an uncoordinated
fashion and will fail to effectively pump blood.
• Defibrillator depolarizes a critical mass of the heart
muscle (most of the cells to fire at once),
synchronize them and allow SA node to takeover
the pacemaker function once again when the heart
repolarizes.
Indications

1. Ventricular Fibrillation

2. Pulseless Ventricular Tachycardia


Why defibrillation of asystole is useless?

• Asystole means there is no electrical activity in the


myocytes i.e. non-functioning of cardiac
pacemakers rather than disorganized functioning
of pacemakers.

• Electrical stimulation of heart activates or


deactivates ion pumps. But, if heart has been long
deprived of oxygen (hypoxia), necessary
electrolytes, etc. – electrical stimulation will not
work.

• So, the primary cause for asystole must be sought


and treated to make the heart tissues excitable
Types of defibrillator

External defibrillator

Internal defibrillator
External defibrillator
Electrodes placed externally
e.g. Portable defibrillator ,Wearable cardiac defibrillator
& Automated external defibrillator (AED).

Internal defibrillator
Electrodes placed directly in endocardium of the heart
[Link] cardioverter defibrillator(ICD).
Monophasic or Biphasic waveform
Defibrillators deliver energy using a monophasic or
biphasic waveform.
Conti…
• Monophasic defibrillators deliver energy in one
direction. Recommendations for monophasic
defibrillators include an initial shock at 360 joules.

• Biphasic defibrillators deliver energy in two


directions. It deliver successful shocks at lower
energies ,the first and any successive shocks
using 120 to 200 joules.
Conti…
The biphasic waveform is preferred over monophasic
waveform to defibrillate.

• Defibrillation more effective at low energy.


• Less trauma
• Less myocardial damage.
Energy selection in paediatrics as per
AHA
• 2j/kg- 4j/kg.
• Not to exceed above 10j/kg.
Paediatric paddle
Types of Defibrillator electrodes
Spoon shaped electrode
• Applied directly to the heart.
• In internal defibrillation, an initial dose of 20 joules is
recommended to avoid burn-like injury to the myocardium.
Care should be taken to avoid coronary vessels to prevent
vessel damage. Subsequent doses can be increased to a
maximum of 40 joules. Sterile internal pads must be used for
internal defibrillation and should be readily available during
any thoracotomy procedures
Conti
Paddle type electrode
• Applied against the chest wall
Conti
Pad type electrode
• Applied directly on chest wall
Position for Defibrillator electrodes
• Anterior-apical position
Conti
• Anterior-posterior position
• There are two accepted positions to optimize current
delivery to the heart:
• (1) Anteroapical – one pad/paddle is placed to the right of
the sternum just below the clavicle, and the other is
centred lateral to the normal cardiac apex in the anterior
or midaxillary line (V5–6)
• (2) Anteroposterior – the anterior pad/paddle is placed
over the precordium or apex, and the posterior pad/paddle
is placed on the back in the left or right infrascapular
region.
Steps In Defibrillation
[Link] code blue, shout for help .gather crash cart
defibrillator and jelly
2. Power on the defibrillator, attach ECG leads and identify
the rhythm
[Link] energy- In adults biphasic 120-200 Joules;
monophasic 360 Joules (in children 2J/kg first shock, second
at 4J/kg, subsequent shocks ≥ 4J/kg not to exceed 10 J/kg or
adult dose)
4. Press charge button on paddle (or monitor)
• [Link] All clear! Ensure no one is touching the patient
including yourself. Keep oxygen away.)
• [Link] the Shock button. Always face the patient when
pressing the shock button.
• 7. Resume CPR, beginning with chest compression for 5
cycles, then recheck rhythm
Conti…
• Ensure proper placement of electrodes on the chest.

• Apply pressure to the paddle and do not lean on


forward.
• Make sure there is no flowing oxygen source in
electrical field.

• State firmly “ I CLEAR, YOU CLEAR, ALL CLEAR”


and deliver shock.
• If VF persists, increase the joule and follow the steps
as before.
Troubleshooting
• 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."
Conti
• Verify that the Energy Select control settings are
correct if the defibrillator does not charge.

• Close the recorder door and the paper roll if the


monitor message reads, "Check recorder”.
After Care of Defibrillator
• If further defibrillation is unnecessary, discharge the
machine by turning it off.

• Once the machine is discharged, clean the paddles


and make sure to remove all conductive jelly.

• Disinfect the defibrillator with Bacillol solution.

• Keep the defibrillator over a dry non insulating surface.

• Connect charger to plug and keep it ready for next


time.
Current European Society of Cardiology and AHA guidelines
suggest the following initial energy selection for specific
arrhythmias
Complications
• Skin burns from the defibrillator paddles are the
most common complication of defibrillation.

• Other risks include injury to the heart muscle.


AED (Automated External Defibrillator)
• Indication

• It is used to provide defibrillation by layperson or healthcare provider.

The device analyzes the heart rhythm and identifies the rhythm if it is
shockable or not.
Equipment required
AED, self-adhesive multifunction defibrillation pads
•

•
FOR PEADIATRIC PATIENTS
• If small pads are not available, adult pads can be used in the
anterior-posterior position. It is important to ensure that the
pads do not touch. The pads cannot be cut to fit the patient
either. A delay in defibrillation for lack of infant pads or low
voltage defibrillator is not recommended. A shock with adult
pads/defibrillator at adult dose is better than not delivering a
shock at all.
Procedure

• 1. Power ON the AED. (some devices power on when the


case or lid is opened)
• 2. Follow AED voice prompts ( written in green):

 Attach pads to patient’s bare chest (adult pads are

applied on a person ≥ 8 years of age) Peel off the


backing of the pads and then attach the adhesive pads
on bare chest, the pad placement is depicted as a
picture on the pads itself. Attach AED connecting cable
to the AED device.
 Analysing rhythm (stop CPR, clear victim, allow the AED
to analyse rhythm)
 It may say shock advised, charging followed by stay
clear and deliver shock, press the flashing button.
 Make sure no one including you is touching the patient
when you press the shock button.
• 3. Resume CPR (5cycles or 2 min) after delivering the shock or in

case no shock is advised by AED.


• Figure: Use of Automated External Defibrillator (AED)
THANK YOU

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