Defibrillator

Defibrillator
Definition
A defibrillator is a device that provides an electric shock to your heart to allow it to get out of
a potentially fatal abnormal heart rhythm, or arrhythmia, — ventricular tachycardia (with no
pulse) or ventricular fibrillation — and back to a normal rhythm. Both of these arrhythmias
happen in your heart’s ventricles or lower chambers.
Defibrillators are devices that send an electric pulse or shock to the heart to restore a normal
heartbeat. They are used to prevent or correct an arrhythmia, an uneven heartbeat that is too
slow or too fast. If the heart suddenly stops, defibrillators can also help it beat again.
Different types of defibrillators work in different ways. Automated external defibrillators
(AEDs), which are now found in many public spaces, are used to save the lives of people
experiencing cardiac arrest. Even untrained bystanders can use these devices in
an emergency.
Other defibrillators can prevent sudden death among people who have a high risk of a life-
threatening arrhythmia. They include implantable cardioverter defibrillators (ICDs), which
are surgically placed inside your body, and wearable cardioverter defibrillators (WCDs),
which rest on the body. It can take time and effort to get used to living with a defibrillator,
and it is important to be aware of possible complications.
PURPOSE
• To correct life threatening fibrillations of the heart, which could result in cardiac arrest.
INDICATION
1. Pulseless ventricular tachycardia
2. Ventricular fibrillation
3. cardiopulmonary resuscitation
4. cardiac dysrhythmias
TYPES OF DEFIBRILLATORS
 MANUAL EXTERNAL DEFIBRILLATOR
 MANUAL INTERNAL DEFIBRILLATOR
 AUTOMATED EXTERNAL DEFIBRILLATOR
 WEARABLE CARDIOVERTER DEFIBRILLATOR
 IMPLANATBLE CARDIOVERTER- DEFIBRILLATOR
MANUAL EXTERNAL DEFIBRILLATOR

 First diagnose the cardiac rhythm and then manually determine the voltage and timing for
the electrical shock
MANUAL INTERNAL DEFIBRILLATOR
 Delivers the shock through paddles directly on the heart
 Used in OT - Open heart surgery
AUTOMATED EXTERNAL DEFIBRILLATOR (AED)

 Defibrillator having rhythm detection capacity and the ability to advise the operator to
deliver a shock using hands free defibrillator pads.
 Untrained or briefly trained laypersons.
 Fully automated or semi automated
IMPLANATBLE CARDIOVERTER- DEFIBRILLATOR

 Consists of a lead system of placed via a subclavian vein to the endocardium.
 A battery powered pulse generator is implanted subcutaneously over pectoral muscle.
 Constantly monitor heart rhythm and automatically administer shocks. Wearable
cardioverter defibrillator.
 Portable external defibrillator that can worn by at risk patient.
 Monitor 24 hrs a day and can automatically deliver a biphasic shock. Monophasic versus
Biphasic waveforms.
 Monophasic defibrillator delivers a charge in only one direction.
 High energy shock (360 -400 J)
Biphasic defibrillator delivers a charge in one direction for half of the shock and in the
electrically opposite direction for second half. (120 -200 J)
CONTRAINDICATION
• Patient who are conscious or have a pulse
• Non shockable rhythm – asystole, pulseless electrical activity
• Multifocal atrial tachycardia
• Dysrhythmia due to enhanced automaticity such as digitalis toxicity.
MECHANISM
• Defibrillator delivers a brief electric shock to the heart which enables the heart’s natural
pacemaker to regain control and establish a normal heart rhythm.
• 3 features
– Power source
– Capacitor
– 2 electrode
FACTORS AFFECTING DEFIBRILLATION

 Transthoracic impendence
 Electrode to skin contact
 Electrode size
 Phase
 Body size
 Electrode position
DEFIBRILLATOR ELECTRODES
• Metal Disc 5 x 10 cm
Types
a. Spoon shaped electrode
b. Paddle type electrode
c. Pad type electrode
EQUIPMENT'S
 Defibrillator with paddle or adhesive patches
 Conductive gel
 ECG monitor with recorder
 Oxygen supply
 Intubation kit
 Multipara monitor – BP, Pulse, Spo2
 Intravenous access
 Suction device
 Code cart with ACLS medication
PROCEDURE
1. Confirm cardiac arrest check for signs of life.

2. CPR should be ongoing.
3. Turn the defibrillator on.
4. Stop chest compression confirm VT from the ECG.
5. Squeeze generous amount of jelly on the defibrillator paddles.
6. The designated person select the appropriate energy on the defibrillator. 150-200 J for
biphasic defibrillators and 150-360 J for monophasic defibrillators.
7. Press ‘charge’ button to charge the capacitor
8. While the defibrillator is charging, warn all rescuers other than the individual performing
the chest compressions to ‘stand clear’ and remove any oxygen delivery device as
appropriate.
9. Once the defibrillator is charged, tell the rescuer doing the chest compressions to “stand
clear”.
10. When clear, discharge the current by pressing both paddle of discharge buttons
simultaneously. Give shock.
11. Examine the patient’s ECG to see whether defibrillation has altered the patient’s
condition and restored the normal rhythm.
12. Continue CPR for 2 min.
13. If desired outcome is not restored, defibrillate again following same procedure.
14. Perform the 3 counter shocks in rapid succession.
15. If the patient still has no pulse after 3 initial defibrillations,
16. Resume CPR.
17. Give supplemental oxygen.
18. Begin administering epinephrine and switch to non shockable algorithm.
19. If further defibrillation is unnecessary, discharge the machine by turning off.
20. Once machine is discharged, clean the paddles / making sure to remove conductive jelly.
21. Any jelly remains the paddle will corrode the metal paddles.
22. Assess patient level of status.
23. Obtain baseline data/ ABG levels and 12 lead ECG.
24. Provide supplemental oxygen, ventilation.
25. Document the procedure.
AUTOMATED EXTERNAL DEFIBRILLATOR
PATIENT PREPARATION
1. Assess the patient to determine if he lacks a pulse.
2. Call for help.
3. Perform resuscitation until the defibrillation and other emergency equipment arrive.
4. As soon as the AED arrives, expose the patient’s chest.
PROCEDURE
Turned on or opened AED.
AED will instruct the user to:-
• Connect the electrodes (pads) to the patient.
• If more than 1 rescuer is present, continue CPR
• Follow the voice/ visual directions
• Avoid touching the patient to avoid false readings by the unit.
• The AED examine the electrical output from the heart and determine the patient is in a
shock able rhythm or not.
• When device determined that shock is warranted, it will charge its internal capacitor in
preparation to deliver the shock.
• When charged, the device instructs the us ensure no one is touching the victim or trolley
and callout ‘stand clear’.
• Then to press a red button to deliver the shock.
• Continue as directed by voice/ visual prompts.
COMPLICATIONS
• Skin burns from the defibrillator paddles are the most common complication of
defibrillation.
• Other risks include injury to the heart muscle, abnormal heart rhythms, and blood clots.
• Myocardial necrosis and myocardial dysfunction
• Pulmonary edema
NURSING MANAGEMENT
• Monitor cardiovascular status.

• Monitor respiratory status
• Monitor neurologic status
• Initiate IV antiarrhythmic therapy
• Monitor for burns
• Documentation
• Patient/ family education.

Defibrillator

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Defibrillator

MANUAL EXTERNAL DEFIBRILLATOR

AUTOMATED EXTERNAL DEFIBRILLATOR (AED)

IMPLANATBLE CARDIOVERTER- DEFIBRILLATOR

FACTORS AFFECTING DEFIBRILLATION

1. Confirm cardiac arrest check for signs of life.

AUTOMATED EXTERNAL DEFIBRILLATOR

• Monitor cardiovascular status.

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