Defibrillation: Indications and Techniques
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rohithDefibrillation: Indications and Techniques
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rohithDEFIBRILLATION
F1
Objectives
To understand:
• What is meant by defibrillation
• The indications for defibrillation
• How to deliver a shock safely using:
– a manual defibrillator
– an automated external defibrillator (AED)
F2
Mechanism of defibrillation
• Definition
“The termination of fibrillation or absence
of VF/VT at 5 seconds after shock
delivery”
• Critical mass of myocardium depolarised •
Natural pacemaker tissue resumes control
F3
Defibrillation
Success depends on delivery
of current to the myocardium
Current flow depends upon:
• Electrode position
• Transthoracic impedance
• Energy delivered
• Body size
F4
Transthoracic Impedance
Dependent upon:
• Electrode size
• Electrode/skin interface
• Contact pressure
• Phase of respiration
• Sequential shocks
F5
Defibrillators
• Design
– Power source
– Capacitor
– Electrodes
• Types
– Manual
– Automated
F6
– Monophasic or Biphasic waveform
Defibrillator waveforms
Damped Monophasic Truncated Biphasic
F7
Biphasic Defibrillators
• Require less energy for defibrillation
– smaller capacitors and batteries
– lighter and more transportable
• Biphasic shocks have higher success
rate for terminating VF/VT than
monophasic shocks
F8
Goals for in-hospital defibrillation
• “Healthcare providers with a duty to
perform CPR should be trained,
equipped, and authorised to
perform defibrillation”
• “The goal should be a collapse-to-
shock interval of less than 3 minutes in
all areas of the hospital”
F9
Automated external defibrillators
• Analyse
cardiac rhythm
• Prepare for
shock delivery
• Specificity for
recognition of
shockable rhythm
close to 100%
F10
Automated external defibrillators
Advantages:
• Less training required
– no need for ECG interpretation
• Suitable for “first-responder” defibrillation
• Public access defibrillation (PAD)
programs
F11
Automated External Defibrillation
• Attach adhesive
electrodes
• Follow audible and
visual instructions
• Automated ECG
analysis - stand clear
• Charges automatically
if shockable rhythm
• +/- manual override
F12
Assess Victim
According to BLS guidelines
AED
BLS
If AED not immediately available Algorithm
Switch defibrillator ON Attach
electrodes Follow spoken/visual
directions
ANALYSE
Shock No shock
Indicated Indicated
After every If no
shock circulation
F13 CPR 2 minutes CPR 2 minutes
Manual Defibrillation
Relies upon:
• Operator recognition of
ECG rhythm
• Operator charging machine
and delivering shock
• Can be used for
synchronised cardioversion
F14
Defibrillator Safety
• Never hold both paddles in one hand
• Charge only with paddles on
casualty’s chest
• Avoid direct or indirect contact
• Wipe any water from the patient’s chest
• Remove high-flow oxygen from zone
of defibrillation
F15
Shock Energy
• Shocks energy 200 J, if biphasic
• Shocks energy 360 J, if monophasic
F16
Manual Defibrillation (1)
• Diagnose VF/VT from ECG
and signs of cardiac arrest
• Select correct energy level
• Charge paddles on patient
• Shout “stand clear” •
Visual check of area •
Check monitor • Deliver
shock
F17
Synchronised cardioversion
• Convert atrial or ventricular tachyarrhythmias
• Shock synchronised to occur with the R wave
• Short delay after pressing discharge buttons
- keep defibrillator electrodes in place
• Conscious patients: sedation or anaesthesia
• Check mode if further shock/s required
F18
Pulseless VT is treated with an
unsynchronised shock using
the VF protocol
F19
Any Questions?
F20
Summary
• Defibrillation is the only effective means
of restoring cardiac output for the patient
in VF or pulseless VT
• Defibrillation must be performed
promptly, efficiently and safely
• New technology has improved machine
performance and simplified use
F21
