DEFIBRILLATION

DR EZECHIEL NTEZIRYAYO
Plan
1. Define defibrillation.
2. Describe Need and history of defibrillation.
3. Describe the principle and mechanism of defibrillation.
4. Types and classes of defibrillator
5. Describe the Automated external defibrillator
6. Identify the precautions and risk
7. Troubleshooting of defibrillator
Definition
• Defibrillators are devices that restore a normal heartbeat by sending an
electric pulse or shock to the heart. They are used to prevent or correct an
arrhythmia, a heartbeat that is uneven or that is too slow or too fast.
• Defibrillators can also restore the heart's beating if the heart suddenly stops
• Defibrillation is a process in which an electronic device sends an electric
shock to the heart to stop an extremely rapid, irregular heartbeat, and
restore the normal heart rhythm.
• Defibrillation is a common treatment for life threatening cardiac
dysrhythmias, ventricular fibrillation, and pulseless ventricular tachycardia.
 NEED FOR DEFIBRILLATOR
• Ventricular fibrillation is a serious cardiac emergency resulting from asynchronous
contraction of the heart muscles.
• Due to ventricular fibrillation, there is an irregular rapid heart rhythm.
NEED FOR DEFIBRILLATOR
• Ventricular fibrillation can be converted into a more efficient rhythm
by applying a high energy shock to the heart.
• This sudden surge across the heart causes all muscle fibers to
contract simultaneously.
• Possibly, the fibers may then respond to normal physiological pace
making pulses.
• The instrument for administering the shock is called a DEFIBRILLATOR
PURPOSE OF DEFIBRILLATION
• Defibrillation is performed to correct life-threatening fibrillations of
the heart, which could result in cardiac arrest.
• It should be performed immediately after identifying that the patient
is experiencing a cardiac emergency, has no pulse, and is
unresponsive.
PRINCIPLE OF DEFIBRILLATION
• Energy storage capacitor is charged at relatively slow rate from AC
line.
• Energy stored in capacitor is then delivered at a relatively rapid rate to
chest of the patient.
• Simple arrangement involve the discharge of capacitor energy
through the patient’s own resistance.
MECHANISM
• Fibrillations cause the heart to stop pumping blood, leading to brain
damage.
• Defibrillators deliver a brief electric shock to the heart, which enables
the heart's natural pacemaker to regain control and establish a
normal heart rhythm.
POWER OF DEFIBRILLATION
• Higher voltages are required for external defibrillation than for
internal defibrillation.
• A corrective shock of 750-800 volts is applied within a tenth of a
second.
• That is the same voltage as 500-533 no of AA batteries!
DIFIBRILLATOR ELECTRODES
• Types of Defibrillator electrodes:
a) Spoon shaped electrode→ Applied directly to the heart.
b) Paddle type electrode → Applied against the chest wall
c) Pad type electrode → Applied directly on chest wall
ELECTRODES PLACEMENT
• Right pad – Right Infraclavicular

• Left pad – Inf-lateral left chest, lateral to the left breast

• Position the pad at least 2.5 cm away from the implantable

medical device
CLASSES OF DISCHARGE WAVEFORM

There are two general classes of waveforms:

a) mono-phasic waveform → Energy delivered in one direction
through the patient’s heart
b) Biphasic waveform → Energy delivered in both direction through
the patient’s heart
CLASSES OF DISCHARGE WAVEFORM
The biphasic waveform is preferred over monophasic waveform to
defibrillate. Why?????
• A monophasic type, give a high-energy shock, up to 360 to 400 joules
due to which increased cardiac injury and burns the chest around the
shock pad sites.
• A biphasic type, give two sequential lower energy shocks of 120 - 200
joules, with each shock moving in an opposite polarity between the
pads.
TYPES OF DEFIBRILLATORS
a) Internal defibrillator
• Electrodes placed directly to the heart
• e.g..-Pacemaker
b) External defibrillator
• Electrodes placed directly on the heart
• e.g..-AED
• For each minute elapsing between onset of ventricular fibrillation and first
defibrillation, survival decreases by 10%. • defibrillators should be portable,
battery operated, small size. • energy in defibrillators usually stored in large
capacitors.
AUTOMATIC EXTERNAL
DEFIBRILLATOR
• AED is a portable electronic device that automatically diagnoses the
ventricular fibrillation in a patient.
• Automatic refers to the ability to autonomously analyse the patient's
condition.
• AED is a type of external defibrillation process.
AUTOMATIC EXTERNAL
DEFIBRILLATOR
• AED is a portable electronic device that automatically diagnoses the
ventricular fibrillation in a patient.
• Automatic refers to the ability to autonomously analyse the patient's
condition.
• AED is a type of external defibrillation process.
AUTOMATIC EXTERNAL
DEFIBRILLATOR
• AEDs require self-adhesive electrodes instead of hand held paddles.
• The AED uses voice prompts, lights and text tell the rescuer what
steps have to take next. messages to tell the rescuer what steps have
to take next.
 WORKING OF AED

Turned on or opened AED.

AED will instruct the user to:
- Connect the electrodes (pads) to the patient.
- 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
WORKING OF AED
• 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 user to ensure no one is
touching the victim and then to press a red button to deliver the
shock.
• Many AED units have an 'event memory' which store the ECG of the
patient along with details of the time the unit was activated and the
number and strength of any shocks delivered
PRECAUTIONS
• The paddles used in the procedure should not be placed:
on a woman's breasts and over an internal pacemaker patients.
• Before the paddle is used, a gel must be applied to the patient's skin
RISKS IN DEFIBRILLATION
• 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.
TROUBLESHOOTING
• Attach the external and internal paddles if the monitor reads, "No
paddles.“
• Check to ensure that the leads are securely attached if the monitor
reads, "No leads.“
• Connect the unit to AC power if the message reads, "Low battery.“
• Verify that the Energy Select control settings are correct if the
defibrillator does not charge.
TROUBLESHOOTING
• Change the electrodes and make sure that the electrodes adapter
cable is properly connected if you receive a message of "PACER
FAILURE." Restart the pacer.
• Close the recorder door and the paper roll if the monitor message
reads, "Check recorder”.
DEFIBRILLATION
AUTOMATED EXTERNAL DEFIBRILLATOR (AED)

• Some AEDs will

automatically switch
themselves on when the
lid is opened
ATTACH PADS TO
CASUALTY’S BARE CHEST
ANALYSING RHYTHM
DO NOT TOUCH VICTIM
SHOCK INDICATED

• Stand clear
• Deliver shock
 SHOCK DELIVERED
FOLLOW AED INSTRUCTIONS

30 2
 NO SHOCK ADVISED
FOLLOW AED INSTRUCTIONS

30 2
 CONTINUE RESUSCITATION UNTIL

• Qualified help arrives and takes over

• The victim starts breathing normally

• Rescuer becomes exhausted