Clinical indication

• Indication for defibrillation : 1.

ventricular fibrillation
2.Pulessless ventricular tachycardia
• Indication for cardioversion
a] supra ventricular tachycardia [
AVNRT/ AVRT]
b] Atrial fibrillation
c] Atrial flutter
d] ventricular tachycardia with pulse
 contraindication
• Arrhythmia with enhanced automaticity
like
Catecholamine induced tachycardia
Digitalis toxicity induced arrhythmias

• Multi focal atrial tachycardia

 Complication
• Most common harmless arhhythmias like
atria / ventricular premature
• Serious complication:
a] ventricular fibrillation
b] thrombo- embolisation
c] myocardial necrosis
d] myocardia stunning
e] pulmonary edema
f] painful skin burns
 Defibrillators maintenance policy
• First, the daily test procedure – 30J self test :
low energy test to check the circuits and the
integrity of cables.

• Second, a weekly check – carried out to test

at higher energy level using ECG simulators

• Third, the detailed half- yearly test procedure

should be performed by the biomedical
department in a hospital
 Daily low energy test
• Step 1: -Put the defibrillator on Battery mode
and ensure machine is disconnected
from the AC power supply.
-Turn the selector switch to ON and select
Manual mode
- Select leads to Paddles/ Pads
• Step 2:
Ensure the universal cable is connected
to the
paddles & place the paddles in a paddle
position
• step 3: Select the energy to 30 J
• Step 4: Press the charge button
• Step 5: the unit charge to 30 J, then the red
LED charge indicator illuminates and
the charge tone sound
• Step 6: Ensure DEFIB. 30J READY display on
screen
• Step 7: Press and hold both paddles SHOCK
button
• Step 8: The unit discharge. Test ok
massage
display and the red LED turns off
• Step 9: The above TEST OK massage
conform
that low energy circuits are in
proper
working condition
Weekly test [Defibrillator internal
discharge test]
Repeat the step from 1 to 9
Step 10: Select Energy button to maximum
energy level 200J display
Step 11: The unit charge 200J, then red LED
charge indicator illuminate and the
charge tone sound
Step 12: Ensure DEFIB 200J READY display on
screen
Step 13: Ensure the machine hold the charge for
50
seconds by giving a long continuous
sound
Step 14: This confirm the unit is fully functional
 cardioversion defibrillator
• Used for organized rhythm • Only for shock able
• Timing of shock w/r/t cardiac arrest i.e. VF &
cardiac cycle pulse less VT
• Avoid R on T phenomenon • No synchronization of
• Set synchronized button shock
• Energy for Atrial flutter 50 • No need to sedation
to 100J[Biphasic]
• Energy used as higher
• Atrial fibrillations 120 to
200J [Biphasic]
• Monophasic 100J for
ventricular tachycardia
• Sedation required
THANK YOU !!