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Questions and Answers
What is the initial shock dose recommended for atrial fibrillation?
What should be avoided when using a defibrillator on a victim?
In which situation is defibrillation contraindicated?
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?
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What can lead to defibrillation failure?
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What is necessary before using a defibrillator?
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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?
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Which component is NOT part of a defibrillator?
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What is the appropriate intervention for unstable tachyarrhythmias?
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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?
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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?
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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)?
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Which cardiac condition is NOT typically treated by defibrillation?
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What does the SA node do in normal cardiac conduction?
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What is the role of the defibrillator?
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Which of the following best describes defibrillation?
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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?
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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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