Defibrillation and Cardioversion

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Information about Defibrillation and Cardioversion

Published on October 15, 2008

Author: aSGuest1023


Defibrillation and Cardioversion : Defibrillation and Cardioversion EMS Professions Temple College Defibrillation : Defibrillation Mechanism Current depolarizes myocardium Induces asystole temporarily Allows one pacemaker to regain control Defibrillation : Defibrillation Factors to consider Duration of VF The longer VF lasts, the harder it is to cure The quicker the better Shock early-Shock often Likelihood of resuscitation decreases 7-10% with each passing minute Defibrillation : Defibrillation Factors to consider Myocardial environment/condition Hypoxia, acidosis, hypothermia, electrolyte imbalance, drug toxicity impede conversion Do NOT delay shock trying to correct problems Defibrillation : Defibrillation Factors to consider Heart size/body weight Pedi requirement lower than adult 2 J/kg initial shock 4 J/kg repeat shocks Direct size/energy relationship in adults unknown 200 to 360 J Defibrillation : Defibrillation Previous countershock Repeated shocks lower resistance Give three initial shocks in 30-45 sec One quickly after another with little time between Defibrillation : Defibrillation Factors to consider Paddle size Adults (large paddles) 10-13 cm diameter Pediatric (small paddles usually < 1 yr) Children 8 cm Infants 4.5 cm Defibrillation : Defibrillation Use largest size that completely contacts chest without paddles touching Small paddles: concentrate current, burn heart Large paddles: reduce current density Defibrillation : Defibrillation Paddle placement One to right of sternum below clavicle; Other to left of left nipple in anterior axillary line Reversing paddles marked “apex--sternum” does NOT affect defibrillation AP placement can be used to defib small children with adult paddles Defibrillation : Defibrillation Paddle-skin interface Cream, paste, saline pads, gelled pads Decreases resistance to current flow Avoid smearing or running: “bridges” charge NEVER use alcohol!!! Defibrillation : Defibrillation Paddle contact pressure Firm pressure of 25 pounds Deflates lungs; Shortens current path Do not lean on paddles; They slip Cardioversion : Cardioversion Definitions Cardioversion Use of electrical shock to interrupt tachycardia Used in Non-Arrest patients only Only VF/VT (pulseless) can be defibrillated Cardioversion : Cardioversion Definitions Synchronized cardioversion Timing of shock to avoid peak of T-wave Prevents VF caused by delivering shock during vulnerable period Cardioversion : Cardioversion Indications Tachyarrhythmias which: Cause or worsen hemodynamic compromise Cause or worsen ischemic heart disease Are resistant to drug therapy Cardioversion : Cardioversion Procedure Oxygen, ECG monitor, IV Patient must be on leads to cardiovert Sedate with Valium or Versed Do NOT make patient unresponsive Cardioversion : Cardioversion Procedure Activate synchronizer Observe marking of complexes May need to unsynchronize if: Random synching occurs Double-synching occurs Cardioversion : Cardioversion Procedure Charge to desired energy setting Depress buttons; Hold until discharge occurs If VF occurs, unsynchronize before defibrillating Cardioversion : Cardioversion If a patient is in VF, why might the defibrillator not discharge if the synchronizer is on?

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