Podcast
Questions and Answers
What is the initial shock dose recommended for atrial fibrillation?
What is the initial shock dose recommended for atrial fibrillation?
What should be avoided when using a defibrillator on a victim?
What should be avoided when using a defibrillator on a victim?
In which situation is defibrillation contraindicated?
In which situation is defibrillation contraindicated?
What is a potential side effect of using an external defibrillator?
What is a potential side effect of using an external defibrillator?
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What is the energy requirement for synchronized cardioversion compared to defibrillation?
What is the energy requirement for synchronized cardioversion compared to defibrillation?
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What can lead to defibrillation failure?
What can lead to defibrillation failure?
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What is necessary before using a defibrillator?
What is necessary before using a defibrillator?
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What is the recommended initial shock dose for ventricular tachycardia with a pulse?
What is the recommended initial shock dose for ventricular tachycardia with a pulse?
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What is the recommended energy level for biphasic defibrillation?
What is the recommended energy level for biphasic defibrillation?
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Which component is NOT part of a defibrillator?
Which component is NOT part of a defibrillator?
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What is the appropriate intervention for unstable tachyarrhythmias?
What is the appropriate intervention for unstable tachyarrhythmias?
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Which of the following sedatives can be used for synchronized cardioversion?
Which of the following sedatives can be used for synchronized cardioversion?
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In which situation would you use a monophasic waveform for defibrillation?
In which situation would you use a monophasic waveform for defibrillation?
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When preparing for synchronized cardioversion, what should be done immediately after placing the paddle on the patient's chest?
When preparing for synchronized cardioversion, what should be done immediately after placing the paddle on the patient's chest?
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Which is the preferred treatment for symptomatic bradyarrhythmia if atropine is not effective?
Which is the preferred treatment for symptomatic bradyarrhythmia if atropine is not effective?
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What is the primary purpose of gel applied before using defibrillation paddles?
What is the primary purpose of gel applied before using defibrillation paddles?
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What is the primary function of an Automated External Defibrillator (AED)?
What is the primary function of an Automated External Defibrillator (AED)?
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Which cardiac condition is NOT typically treated by defibrillation?
Which cardiac condition is NOT typically treated by defibrillation?
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What does the SA node do in normal cardiac conduction?
What does the SA node do in normal cardiac conduction?
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What is the role of the defibrillator?
What is the role of the defibrillator?
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Which of the following best describes defibrillation?
Which of the following best describes defibrillation?
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Which type of AED provides voice and visual prompts to the user?
Which type of AED provides voice and visual prompts to the user?
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What commonly results from disturbances in the cardiac conduction system?
What commonly results from disturbances in the cardiac conduction system?
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Which of the following is NOT a characteristic of electrical therapy?
Which of the following is NOT a characteristic of electrical therapy?
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Study Notes
Electrical Therapy
- Electrical therapy is a method of stimulating the body using electrodes placed on the skin.
- An electrical current is transmitted to these electrodes, causing the depolarization of sensory nerves and increasing muscle strength.
- This therapy is used to treat a variety of conditions, including muscle atrophy, pain, and paralysis.
Automated External Defibrillator (AED)
- An AED is a portable device that analyzes a person's heart rhythm and delivers an electric shock if needed.
- AEDs are used to treat sudden cardiac arrest (SCA) caused by ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT).
- There are two types of AEDs: semi-automatic and fully automatic.
- Semi-automatic AEDs require the user to press a button to deliver the shock, while fully automatic AEDs deliver the shock without user input.
Defibrillation
- Defibrillation is a common treatment for life-threatening cardiac arrhythmias, like VF and pulseless VT.
- It involves delivering a therapeutic dose of electrical energy to the heart using a defibrillator.
- Two types of defibrillators exist: impedance-based and current-based.
- Defibrillation is typically performed with either monophasic or biphasic waveforms.
- Monophasic defibrillators deliver a single electric pulse, while biphasic defibrillators deliver two pulses in opposite directions.
- Biphasic defibrillators often require lower energy levels than monophasic defibrillators.
Components of a Defibrillator
- Defibrillators have three main components:
- The machine itself,
- Paddle electrodes, and
- Cables that connect the paddles to the machine.
Synchronized Cardioversion
- Synchronized cardioversion is a treatment used for unstable tachyarrhythmias.
- It involves delivering a synchronized electric shock to the heart.
- Before performing cardioversion, patients need to be prepared with:
- Consent (if possible),
- Pre-medication with sedatives and analgesics like midazolam, etomidate, ketamine, fentanyl, or morphine,
- Monitoring, gel, and an emergency trolley.
- Energy levels can be adjusted based on the type of rhythm being treated – 50-100 J for narrow SVT, 120 J for irregular AF, 100 J for wide VT.
- The synchronized button on the defibrillator must be activated to ensure the shock is delivered in sync with the R wave or QRS complex.
Transcutaneous Pacing
- Transcutaneous pacing is used to treat symptomatic bradyarrhythmias that do not respond to atropine.
- Alternative treatments include IV adrenaline infusion (1-10mcg/min) or IV dopamine infusion (2-10mcg/kg/min).
- It is preferred in AMI with bradycardia to minimize the stress response caused by adrenaline or dopamine.
Paddle Placement for Transcutaneous Pacing
- Four common paddle positions are utilized:
- Antero-lateral
- Antero-posterior
- Anterior-left infra-scapular
- Anterior-right infra-scapular
Energy Levels for Defibrillation and Cardioversion
- Energy levels for defibrillation and cardioversion vary based on the rhythm being treated:
- Ventricular fibrillation or pulseless ventricular tachycardia – 300 J monophasic or device-specific biphasic (150-200 J)
- Atrial fibrillation – 100-200 J monophasic or 100-120 J biphasic
- Atrial flutter and other SVTs – 50-100 J monophasic or 100-120 J biphasic
- Ventricular tachycardia (with pulse) - 100 J monophasic or device-specific biphasic
Factors Influencing Defibrillation Success
- Factors that can affect defibrillation success:
- Hairy chest
- No gel medium
- Gel smear between paddles
- Body fat
- Distance between paddles
- Weight application on paddles (10 kg per paddle)
- Serial shocks
- Time lag between arrhythmia onset and shock
Defibrillation Contraindications
- Defibrillation is contraindicated in the following situations:
- The patient’s desire not to be resuscitated has been clearly expressed and documented.
- There is immediate danger to the rescuers due to the environment, patient location, or patient condition.
Defibrillation Side Effects
- The most common side effect of defibrillation is skin burns at the paddle placement areas.
- Unintentional shock, which can be painful, is another potential side effect, especially for people touching the patient during defibrillation.
Defibrillation Precautions
- Precautions for defibrillation include:
- Awareness of oxygen and fire risks.
- Proper technique to prevent charging or placing paddles directly onto the patient.
- Never allowing oxygen flow directly onto the victim.
- Proper care and maintenance of the defibrillator, including general checkout, testing, battery replacement, and cleaning.
Defibrillation vs. Synchronized Cardioversion
- Defibrillation delivers energy during any phase of the cardiac cycle and is used for patients who are pulseless. Higher energy levels are typically required.
- Synchronized Cardioversion delivers energy synchronized to the R waves or QRS complex, requiring lower energy levels. Used for patients who are conscious.
Troubleshooting Defibrillation Issues
- If defibrillation is unsuccessful, check the following:
- Paddle or electrode position
- Adequate skin contact
- Consider changing the defibrillator pads.
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