Cardioversion lecture

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Presentation Transcript

Slide 1: 

2010/10/23 prepared by : thamer aldhoun 1 Cardioversion and Defibrillation

Slide 2: 

1- definition of cardioversion and defibrillation 2- indications for both of them 3- techniques 4- type of defibrillators 5- monophasic vs biphasic 6- nursing intervention 2010/10/23 prepared by : thamer aldhoun 2 outline

Slide 3: 

By the end of this lecture you will be able to: 1- define the process of cardioversion and defibrilltion 2- recognized the indication for using cardioversion and defibrillation 3- be aware of the precautions that should be taken when applying this procedure 2010/10/23 prepared by : thamer aldhoun 3 objectives

Slide 4: 

4- be familiar with the techniques 5- recognize type of defibrillator 6- distinguish between monophasic and biphasic defibrillators 7- be aware of the complication 2010/10/23 prepared by : thamer aldhoun 4

Cardioversion : 

Cardioversion Definition : It is a procedure in which electrical current administered in synchrony with the patient own QRS to stop dysrythmia. The electrical impulses discharge during ventricular depolarization 5 prepared by : thamer aldhoun 2010/10/23

Indications : 

Indications 1- To treat rapid AF rhythm, not responding to medical therapy. 2- pulse VT 3- SVT 6 prepared by : thamer aldhoun 2010/10/23

Cardioversion can be elective or emergency : 

Cardioversion can be elective or emergency 7 prepared by : thamer aldhoun 2010/10/23

If elective cardioversion : 

If elective cardioversion 1- If AF start since more than 48 hr, pt should be started on anticoagulation for few weeks before cardioversion indicated, INR more than 2 8 prepared by : thamer aldhoun 2010/10/23

Slide 9: 

2- Digoxin is usually withhold for 48 hr before cardioversion to ensure the resumption of sinus rhythm with normal conduction 3- transthoracic echocardiogram or TEE can be apply 9 prepared by : thamer aldhoun 2010/10/23

Slide 10: 

4- patient should be fasting at least 8hr before the procedure. 5- Before cardioverion patient receives IV sedation or ansthesia. 6- shaving at site of procedure apply if necessary. 10 prepared by : thamer aldhoun 2010/10/23

Technique : 

Technique When the procedure ensure the nurse should be: Consent form 1- insert canulla . 2-check vital sign 3- applying ECG 11 prepared by : thamer aldhoun 2010/10/23

Slide 12: 

4-check environment at site procedure. 5- emergency trolley should be on hand. 6- defibrillator machine 7- put patient on monitor 12 prepared by : thamer aldhoun 2010/10/23

Slide 13: 

8- give patient sedation as prescription. 9-continous observe vital sign 10- ensure monitor leads are attach to patient and check the synchronize button on sync mode 13 prepared by : thamer aldhoun 2010/10/23

Slide 14: 

11- but conductor pads at the appropriate site 12- put the appropriate voltage as Dr prescription 13- the Dr give shock 14 prepared by : thamer aldhoun 2010/10/23

Slide 15: 

14- the Dr should be say “clear” 3 time before give it. 15- record the delivery energy and the result. 16- if successful response check peripheral pulses ,blood pressure, airway patency and LOC. 15 prepared by : thamer aldhoun 2010/10/23

Slide 16: 

17- inspect the skin under the paddles for burns. 18-ECG monitoring is required during and after cardioversion. If not successful check the physician order 16 prepared by : thamer aldhoun 2010/10/23

defibrillation : 

defibrillation It is electrical current administered to stop a dysrhythmia , not synchronizd with the patient’s QRS complex. or is the treatment for immediately life-threatening arrhythmias with which the patient does not have a pulse, i.e. VF or pulseless VT 17 prepared by : thamer aldhoun 2010/10/23

Slide 18: 

Precautions: Defibrillation should not be performed on a patient who has a pulse or is alert, as this could cause a lethal heart rhythm disturbance or cardiac arrest 18 prepared by : thamer aldhoun 2010/10/23

Type of defibrillators : 

Type of defibrillators 1- Automated external defibrillators AEDs: These are useful, as their use does not require special medical training They are found in public places, e.g. offices, airports, shopping centers They analyze the heart rhythm and then charge and deliver a shock if appropriate 19 prepared by : thamer aldhoun 2010/10/23

Continue : 

Continue 2- semi automated external defibrillators : -These are compramise between full manual unit and automated unit. -They are mostly used by pre-hospital care professional such as paramedics -can be overridden and usually have an ECG display 20 prepared by : thamer aldhoun 2010/10/23

semi automated external defibrillators : 

semi automated external defibrillators 21 prepared by : thamer aldhoun 2010/10/23

Slide 22: 

3- Standard defibrillators with monitor: They used in hospitals and have two type: A- monophasic : the current travels only in one direction for one paddle to another 22 prepared by : thamer aldhoun 2010/10/23

Slide 23: 

B- Biphasic : the current travels towards the positive paddle and then reverses and goes back ** Biphasic shocks deliver one cycle every 10 milliseconds 23 prepared by : thamer aldhoun 2010/10/23

Slide 24: 

** Biphasic associated with fewer burns and less myocardial damage than monophasic ** With monophasic shocks, the rate of first shock success in cardiac arrests due to a shockable rhythm is only 60%, whereas with biphasic shocks, this increases to 90%. 24 prepared by : thamer aldhoun 2010/10/23

Slide 25: 

25 prepared by : thamer aldhoun 2010/10/23

Continue : 

Continue 4- implantable cardioverter defibrillator ICD : Is advice that detects and terminates life-threatening episodes of VT or VF in high risk patient. 26 prepared by : thamer aldhoun 2010/10/23

Slide 27: 

- when dysrhythmia occurs , rate sensors take 5 to 10 seconds to sense the dysrhythmia. -- then the device takes several seconds to charge and deliver the programmed charge through the lead to the heart --battery life is about 5 years 27 prepared by : thamer aldhoun 2010/10/23

Indication for defibrillation : 

Indication for defibrillation 1- VF 2- pulseless VT 28 prepared by : thamer aldhoun 2010/10/23

Technique : 

Technique The shock give in emergency situation the nurse should be ensure safety precaution for patient and health provider end other people * Ensure patency of canulla * For patient ensure using conductor pads to prevent burn * The voltage determine by Dr , but some researched say the shock start from 360j 29 prepared by : thamer aldhoun 2010/10/23

Slide 30: 

**After the procedure ECG should be apply ** the nurse observe vital sign and patency of airway 30 prepared by : thamer aldhoun 2010/10/23

Slide 31: 

The End Prepared by Thamer aldhoun 31 prepared by : thamer aldhoun 2010/10/23

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