Electrical Therapy in Basic Life Support PDF

ELECTRICAL THERAPY IN BASIC LIFE SUPPORT 3 Julai 2018 BLOK PEMBELAJARAN SUMBER PELAJAR, KAMPUS KESIHATAN, USM  Electrical therapy was an electrical stimulation by placing a lead wires and electrodes on the skin over the target areas of the body...

ELECTRICAL THERAPY IN BASIC LIFE SUPPORT 3 Julai 2018 BLOK PEMBELAJARAN SUMBER PELAJAR, KAMPUS KESIHATAN, USM  Electrical therapy was an electrical stimulation by placing a lead wires and electrodes on the skin over the target areas of the body When the device activated, a signal is transmitted down the lead to the electrode and cause depolarization of sensory nerves to increase muscle strength of atrophied muscles 1. AED 2. Defibrillation 3. Synchronized Cardioversion 4. Cardiac monitor 5. Transcutaneous Pacing  NORMAL CARDIAC CONDUCTION SA node generates electrical impulse. Impulse propagates via cardiac conduction system. Impulse reaches cardiac muscles (myocardium) causing myocardial contraction. Myocardial contractions need to be rhythmic and in proper order to allow efficient contraction of the heart in order to pump blood throughout the body. Disturbance in this conduction system may disturb cardiac function AUTOMATED EXTERNAL DEFIBTILATOR AUTOMATED EXTERNAL DEFIBTILATOR is a portable & computerized device that incorporates heart rhythm then send an electric shock to the heart to try to restore a normal rhythm. AEDs are used to treat sudden cardiac arrest (SCA). Used voice / visual prompts to guide lay rescuers to safely defibrillate victims of cardiac arrest D/T VF or pulseless VT 2 types : Semi automatic : Fully automatic DEFIBRILLATION  Defibrillation is a common treatment for life- threatening cardiac arrhythmias, ventricular fibrillation, and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator http://www.livestrong.com/article  Defibrillator is the device used to deliver that shock and it can be manual or automatic. 2 Types Impedance based defibrillators Current based defibrillator CONT.. * Biphasic: 120-200J * Monophasic: 360J MONOPHASIC WAVEFORM BIPHASIC WAVEFORM 17  3 COMPONENT OF DEFIBRILATOR: Machine Paddle cable SYNCHRONIZED CARDIOVERSION SYNCHRONIZED CARDIOVERSION Treatment for unstable tachyarrhythmias Prepare the patient: – Consent (if possible) – Pre-medicate with sedative and analgesic if appropriate – Sedative: midazolam, etomidate, or ketamine – Analgesic: fentanyl, or morphine – Monitoring, gel and emergency trolley  Patient conscious Preparation: – consent – IV Access – Sedation and analgesic – Emergency trolley Switch on SYNCH button and select appropriate energy.  Confirm synch light on and synchronize line appear on each R wafe. Place paddle on patient chest. Charge defib and clear patient. Discharge and place paddle immediately on machine. Switch off synch button. Synchronized Cardioversion Dose Regular Irregular Narrow 50-100 J 120 J (SVT) (AF) Wide 100 J Defibrillate (VT*) (polymorphic VT**) *SVT with aberrancy will have wide, regular rhythm. We may differentiate this from the ECG. Treatment is the same as in SVT. However, if in doubt, treat as VT. **Atrial fibrillation with aberrancy or pre-excitation AF will have wide, irregular rhythm. Acute management is the same as AF. Transcutaneous Pacing Transcutaneous Pacing Treatment for symptomatic bradyarrhytmia if not responding to atropine Other treatment available: – IV adrenaline infusion 1-10mcg/min – IV Dopamine infusion 2-10mcg/kg/min Preferably in AMI with bradycardia to avoid stress effect from adrenalin, dopamine  LOCATION OF 4 PADDLES; Antero-lateral position Antero-posterior position Anterior-left infra-scapular position Anterior – right infra-scapular position  RYTHM MONOPHASIC BIPHASIC 1. Ventricular 300J Device Spesific OR 150J to Fibrillation OR Pulseless 200J Ventricular Tachycardia FOR 2nd and subsequant dose use similar or higher dose 2. Atrial fibrillation 100J to 200J 100J to 120J (initial dose) 3. Atrial Flutter And 50J to 100J (initial 100J to 120J (initial dose) Other SVTs dose) 4. Venricular 100J (initial dose) Device Spesific Tachycardia (With Pulse) Circulation 2015 Ventricullar Fibrillation Ventricular Tachycardia  Hairy chest  No gel medium  Gel smear between two paddles  Body fat  Distance between two paddles  Weight application on paddle (10kg per paddle)  Serial shock  Time lag between arrhythmia onset and shock  DEFIBRILATION CONTRA INDICATION 1. The patient's desire not to be resuscitated has been clearly expressed and documented. 2. Immediate danger to the rescuers is present due to the environment, patient's location, or patient's condition.  SIDE EFFECT OF DEFIBRILATOR 1. Skin Burns Burns on the paddle placement areas are the most common side effect of external defibrillators. 2. Unintentional Shock People touching a person being defibrillated may receive a shock themselves. This may be painful - according to the American Heart Association.  PRECAUTIONS 1. Oxygen & Fire Risk Burns on the paddle placement areas are the most common side effect of external defibrillators. 2. Technique Avoid - charging / placing the paddle - direct contact with victim - allowing oxygen flow onto victim’s  FAILURE OF DEFIBRILLATION Check paddle or electrode position Check that there is adequate skin contact Consider changing the defibrillator pads  CARE OF THE DEFIBRILLATOR General checkout Testing Batteries Cleaning  DEFIBRILLATION VS SYNCHRONIZED CARDIOVERSION DEFIBRILLATION SYNCHRONIZED CARDIOVERSION Delivered of energy during any phase Delivered of energy that is of the cardiac cycle. synchronized to the R waves or QRS complex. High energy required. Lower energy required. Patient must be pulseless. Patient conscious. Anesthesia :is an emergent maneuver Anesthesia : performed under and when necessary. sedation. Indication: Pulseless VT, VF and Indication : SVT, AF, Atrial Flutter Cardiac arrest due to or resulting in VF. REMEMBER! !  2 critical questions about CPR+ defibrillation ? CPR should be provided before defibrillation is attempted Number of shocks to be delivered in a sequence before the rescuer resumes CPR