Defibrillation and Cardioversion

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Defibrillation and Cardioversion : 

Defibrillation and Cardioversion EMS Professions Temple College

Defibrillation : 

Defibrillation Mechanism Current depolarizes myocardium Induces asystole temporarily Allows one pacemaker to regain control

Defibrillation : 

Defibrillation Factors to consider Duration of VF The longer VF lasts, the harder it is to cure The quicker the better Shock early-Shock often Likelihood of resuscitation decreases 7-10% with each passing minute

Defibrillation : 

Defibrillation Factors to consider Myocardial environment/condition Hypoxia, acidosis, hypothermia, electrolyte imbalance, drug toxicity impede conversion Do NOT delay shock trying to correct problems

Defibrillation : 

Defibrillation Factors to consider Heart size/body weight Pedi requirement lower than adult 2 J/kg initial shock 4 J/kg repeat shocks Direct size/energy relationship in adults unknown 200 to 360 J

Defibrillation : 

Defibrillation Previous countershock Repeated shocks lower resistance Give three initial shocks in 30-45 sec One quickly after another with little time between

Defibrillation : 

Defibrillation Factors to consider Paddle size Adults (large paddles) 10-13 cm diameter Pediatric (small paddles usually < 1 yr) Children 8 cm Infants 4.5 cm

Defibrillation : 

Defibrillation Use largest size that completely contacts chest without paddles touching Small paddles: concentrate current, burn heart Large paddles: reduce current density

Defibrillation : 

Defibrillation Paddle placement One to right of sternum below clavicle; Other to left of left nipple in anterior axillary line Reversing paddles marked “apex--sternum” does NOT affect defibrillation AP placement can be used to defib small children with adult paddles

Defibrillation : 

Defibrillation Paddle-skin interface Cream, paste, saline pads, gelled pads Decreases resistance to current flow Avoid smearing or running: “bridges” charge NEVER use alcohol!!!

Defibrillation : 

Defibrillation Paddle contact pressure Firm pressure of 25 pounds Deflates lungs; Shortens current path Do not lean on paddles; They slip

Cardioversion : 

Cardioversion Definitions Cardioversion Use of electrical shock to interrupt tachycardia Used in Non-Arrest patients only Only VF/VT (pulseless) can be defibrillated

Cardioversion : 

Cardioversion Definitions Synchronized cardioversion Timing of shock to avoid peak of T-wave Prevents VF caused by delivering shock during vulnerable period

Cardioversion : 

Cardioversion Indications Tachyarrhythmias which: Cause or worsen hemodynamic compromise Cause or worsen ischemic heart disease Are resistant to drug therapy

Cardioversion : 

Cardioversion Procedure Oxygen, ECG monitor, IV Patient must be on leads to cardiovert Sedate with Valium or Versed Do NOT make patient unresponsive

Cardioversion : 

Cardioversion Procedure Activate synchronizer Observe marking of complexes May need to unsynchronize if: Random synching occurs Double-synching occurs

Cardioversion : 

Cardioversion Procedure Charge to desired energy setting Depress buttons; Hold until discharge occurs If VF occurs, unsynchronize before defibrillating

Cardioversion : 

Cardioversion If a patient is in VF, why might the defibrillator not discharge if the synchronizer is on?

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