Defibrillation

What is a defibrillator?

A defibrillator is a device that sends electrical energy, or shock, to the heart.

The aim of using a defibrillator is to treat cardiac arrest.

The need for this generally arises when the patient has ventricular fibrillation
or ventricular tachycardia, which are life threatening arrhythmias that occur
when contraction of the ventricles become abnormal.

Defibrillators have electrocardiogram (ECG) leads and adhesive patches (or

paddles).

The adhesive electrodes are the patches placed on the patient's chest that
deliver the electric shock.
Types of Defibrillators

There are different kinds of defibrillators in use today.

They include the
● manual external defibrillator,
● manual internal defibrillator,
● automated external defibrillator (AED),
● implantable cardioverter-defibrillator (ICD),
● wearable cardiac defibrillator.
Manual external defibrillator

These defibrillators require more experience and training to

effectively handle them. Hence, they are only common in hospitals
and a few ambulances where capable hands are present. In
conjuntion with an ECG, the trained provider determines the
cardiac rhythm and then manually determines the voltage and
timing of the shock-through external paddles to the patient's chest.
Implantable cardioverter defibrillator

Another name for this is automatic internal cardiac defibrillator

(AICD). They constantly monitor the patient's heart, similar to a
pacemaker, and can detect ventricular fibrillation, ventricular
tachycardia, supraventricular tachycardia, and atrial fibrillation.
When an abnormal rhythm is detected, the device automatically
determines the voltage of the shock to restore cardiac function.
Manual internal defibrillator

The manual internal defibrillators use internal paddles to

send the electric shock directly to the heart. They are used
on open chests, so they are only common in the operating
room. It was invented after 1959.
Wearable cardiac defibrillator

Further research was done on the automatic internal cardiac

defibrillator (AICD) to bring forth the wearable cardiac defibrillator, which
is a portable external defibrillator generally indicated for patients who are
not in an immediate need for an AICD. This device is capable of
monitoring the patient 24-hours-a-day. It is only functional when it is worn
and sends a shock to the heart whenever it is needed .
Automated external defibrillator (AED)

These are defibrillators that use computer technology, thereby

making it easy to analyze the heart's rhythm and effectively
determine if the rhythm is shockable. They can be found in
medical facilities, government offices, airports, hotels, sports
stadiums, and schools.
Automated external defibrillator

• AED is a portable type of external defibrillator that automatically

diagnose the ventricular fibrillation in a patient.

• Automatic refers to the ability to autonomously analyze the

patients condition.
AED is provided with self-adhesive electrodes instead of hand held
paddles.
Principle
Integration of AED use with basic life support measure. When
arriving at the scene of a suspected cardiac arrest, rescuers
must rapidly integrate cardiopulmonary resuscitation (CPR) with
the use of the available AED. Interrupt CPR only when it is
necessary to analyze the rhythm and deliver a shock.
WORKING
Automatically Checks victims heart rhythm to detect fibrillation.
▪ Advises whether victim needs a Shock.
• The Shock (defibrillation) is an attempt to return heart to a
more normal rhythm.
How to use an aed

Turn on the AED

Expose Chest
To Attach Pads
Plug in Connecter
Stay Clear
Analyze the Rhythm
Deliver Shock
After Shock
Perform CPR
Paddle placement
Placement of paddle
Positions
Anterior-lateral > most convenient
Anterior-posterior
Anterior-left infrascapular
Anterior-right infrascapular
Anterior-lateral position ---
one-right of sternum below clavicle (2nd & 3rd ICS) other-left
4th or 5th ICS mid axillary line
Reversing paddle markings "sternum & apex" does not affect
defibrillation
Paddles placed along axis of heart.
AP-placement used in children with adult paddles.
Position of electrodes in pregnant patients:
-One on right of sternum below the right clivcle
-Other left mid-axillary line avoiding breast
Paddle size

- Adult - large paddles

10-13 cm diameter
- Pediatric - small paddles <1yr Infant <10kgs-4.5cm
Children >10kgs- 8cm
Functions of aed

■ An AED is an electronic device that analyses the heart

rhythm and if necessary delivers a shock, known as
defibrillation.
Safety precautions of aed

● Perspiration
● Patches
● Pendants
● Piercings
● Pacemaker
● Shaving
 Points to remember in in-hospital defibrillation
● Be careful about the SYNC button. It is to be ON in cardioversion and
OFF in defibrillation.
● The staff delivering the shock has to be calm and deliberate.
● No one should be in contact with the bed or the patient before defibrillator
is discharged.
● Use adhesive defibrillations pads where ever possible. If it is not
available, use only enough gel in contact with the chest as it may trigger a
spark
● The rescuer/person delivering the shock should not have gel in his/her
hands. Remove metal objects, jewellery (if any) from the patient's chest.
● to cover the paddle surface
● If the patient has temporary pacemaker, it should be turned off. In case of
permanent pacemaker, keep the paddles at least 8-10 cm away from the
pacemaker insertion pocket.
● Fire hazard.