DC Shock

Mohammed Youssry
Critical Care & Emergency Nursing Department
 Objectives
:At the end of this session every student will be able to

– Define the DC shock

– List the indications of DC Shock.
– Differentiate between Defibrillation and Cardioversion.
– Discriminate between the two types of defibrillators.
– Perform the DC shock procedure correctly.
– Enumerate the complications of DC shock.
– Utilize correct documentations.

08/22/2023 Critical Care & Emergency Department - M. Youssry 2

 Outlines
– Definition
– Indications
– Defibrillation and Cardioversion
– Synchronization
– Types of defibrillators
– Procedure
– Complications
– Documentations

08/22/2023 Critical Care & Emergency Department - M. Youssry 3

 DC – Shock
• DC  Direct Current

• Direct an electric current through the

patient’s heart.

• Causes myocardium to depolarized

(stop active electrical activity).

• Induce asystole temporarily.

• Allows SA node to regain control.

08/22/2023 Critical Care & Emergency Department - M. Youssry 4

 Indications
• Ventricular arrhythmias: • Atrial arrhythmias:

1. Ventricular Fibrillation (VF) 1. Atrail Fibrillation (AF)

2. Ventricular Tachycardia (VT) 2. Atrial flutter

08/22/2023 Critical Care & Emergency Department - M. Youssry 5

 Defibrillation and Cardioversion
Defibrillation Cardioversion

Used mainly to treat ventricular Used mainly to treat atrial

dysrhythmias dysrhythmias
( Ventricular Fibrillation and Pulseless VT) (Atrial Flutter, Atrial Fibrillation)

Emergency and life threatening Elective and can be scheduled

Client is not sedated before the Client should be sedated before
procedure. the procedure
Uses maximum electrical energy Uses less electrical energy

Deliver the electrical energy when Deliver the electrical energy

the buttons on the paddles are when it senses the R wave of the
pressed ECG

08/22/2023
Critical Care & Emergency Department - M. Youssry 6
 Synchronization
• Delivers an electric charge to the myocardium
at he peak of the R wave

08/22/2023 Critical Care & Emergency Department - M. Youssry 7

 Types of defibrillators
• Monophasic:
– One way current
– High joules 200 J
– More complications

• Biphasic: 36
0 j
200 J
– Two ways current
– Lower joules
– Less complications
08/22/2023 Critical Care & Emergency Department - M. Youssry 8
 Types of Defibrillation
Internal Defibrillation -1
The device may be implanted directly in 
.the user of the device

So it is known as an Impalantable
cardioverter-defibrillator (ICD)

This type of defibrillator is designed to 

provide immediate defibrillation to high-
. risk patients
Automated External defibrillator (AEDs) -2
.Safer and cheaper
Automated External defibrillator (AEDs) -2
 .External defibrillators -3
External defibrillators are typically used in
.hospitals or ambulances
 Procedure

Place patient in safe environment (no water, .1

.metal)
.Remove any transdermal medication patches .2

Confirm rhythm on monitor, check patient’s .3

.pulse, run a ECG strip for documentation

.Apply conductive gel to the patient’s chest .4

4. Select energy setting Shock (200 J biphasic)
or (360 J Monophasic).

5. Charge paddles.

6. Place paddles on the chest :

– One under the right clavicle, right parasternal
– The other one in the left anterior axillary line
(5th intercostal space).
 Check that no one is touching the patient or in .7
contact with any conductive material in contact
.with patient

.State “CLEAR” loudly confirm rhythm patient .8

Depress both red buttons simultaneously or .9

.press shock button (hands free)

Reconfirm rhythm on monitor after a few .10

.seconds
 Critical Care & Emergency Department - M.
08/22/2023 17
Youssry
 Aftercare
• After defibrillation, the patient's cardiac status,
breathing, and vital signs are monitored .

• Additional tests to measure cardiac damage will

be performed, as 12 lead electrocardiogram, a
chest x-ray, and cardiac catheterization .

• Clean the patent’s chest to remove gel and, if

necessary, electrical burns are treated.
 Complications

• Aspiration

• Bradycardia or cardiac arrest

• Clot embolism
• Ineffective shock  recurrence
• Skin burn

• Pain
08/22/2023 Critical Care & Emergency Department - M. Youssry 19
 Documentation
• Documentation include:
– Pre defibrillation ECG rhythm.
– Post defibrillation ECG rhythm.
– Number of DC shocks.
– The joules used in each shock.
– Whether the pulse returned.
– Drugs (dose – routes – time).
– How the air way was maintained.
– Patient outcome.

08/22/2023 Critical Care & Emergency Department - M. Youssry 20

Procedure
08/22/2023 Critical Care & Emergency Department - M. Youssry 21