Basics of Defibrillation

Overview:

Defibrillation is the process of delivering a controlled electrical current through the heart during cardiac arrest to terminate an abnormal electrical rhythm.

Types of devices:

  • Automated External defibrillator (AED).
  • Internal defibrillator.
  • Manual defibrillator.
  • Semi-automated defibrillator.
  • Implantable cardioverter-defibrillator (ICD).
  • Wearable Defibrillators.

In this article we will cover the manual defibrillator.

Manual defibrillator

Interface:

What is used to conduct the electrical current from the device to the patient.

  • Hand-held paddle.
  • Self-adhesive pads.

Positioning:

Conventional positions (anterolateral)

  • One paddle is placed on the left fourth or fifth intercostal space on the midaxillary line.
  • The second paddle is placed just to the right of the sternal edge on the second or third intercostal space.
Conventional positions (anterolateral)

Type of waveforms:

(depend on the device)

  • Monophasic.
  • Biphasic.

Factors that affect success rate:

  • Early defibrillation.
  • Energy selected.
  • Electrode size.
  • Paddle–skin coupling material.
  • Number and time interval of previous shocks.
  • Phase of ventilation.
  • Distance between electrodes (size of the chest).

Indicatons:

  • Ventricular fibrillation (VF).
  • Pulseless Ventricular Tachycardia (pVT).

Contraindications:

  • Non shockable rhythms include:
    • Asystole.
    • Pulseless electrical activity.
  • Patient presenting with signs of life.

Complications:

  • Directly injuring myocardial cells.
  • Inducing post-shock dysfunction.
  • Refibrillation.
  • Skin burns.
  • Explosion.
  • Transmitted shock to the operator.

Doses:

  • 200 J for monophasic.
  • 360 J for Biphasic.

Procedure (The ARC Guidelines 2016):

Required a very good communication and a trained team

C: Compressions Continue
O: Oxygen away (if free flowing BVM)
A: All others clear
C: Charging defibrillator
H: Hands off (compressor should say I’m safe)
E: Evaluating rhythm
D: Defibrillate or Disarm

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