Defibrillation

From Anvita Health Wiki

Contents 1 Indications 2 Contraindications 3 Procedure 4 Notes 5 More General Terms 6 Additional Terms 7 References

Indications

• termination of life-threatening ventricular arrhythmias

• ventricular tachycardia ( VT)
• ventricular fibrillation/flutter ( VF)

• termination of supraventricular tachyarrhythmias

• hemodynamic compromise
• atrial fibrillation/ atrial flutter refractory to carotid sinus massage or chemical cardioversion
• if atrial fibrillation/ atrial flutter is known to be of < 48 hours in duration, attempt synchronized cardioversion
• patients without hemodynamic compromise for which atrial fibrillation/ atrial flutter may be of > 48 hours in duration should be anticoagulated for 3 weeks prior to cardioversion & anticoagulation should be continued for 3 weeks after cardioversion
• synchronized cardioversion

• begin 50 joules
• then 100, 200, 300, 360 joules

Contraindications

• atrial fibrillation with digitalis toxicity toxicity should be alleviated before cardioversion/ defibrillation

Procedure

• Protocol: automated external defibrillator

• Also see protocol for manual defibrillators

• turn on defibrillator
• attach to victim

• select correct pad size for victim's size & age
• open package, expose adhesive surface & attach to victim upper right sternal border & cardiac apex
• attach directly to chest wall, do NOT defibrillate through clothing
• attach cables if needed

• analysis, place in analysis mode

• announce 'Analyzing rhythm - stand clear'
• verify

• no victim movement
• no one in contact with victim

• analyze, press analyze (some AEDs omit this control)

• shock

• if VF/ VT is present, AED will charge to 150-360J
• announce ' shock is indicated - stand clear'
• verify no one is touching victim
• apply 25 lbs of pressure on both paddles
• press 'shock' button'

• resume CPR after shock

• continue CPR for 2 minutes prior to analyzing rhythm
• cycles of 2 minutes of CPR, analyze rhythm, shock if rhythm is shockable
• repeat cycle of 2 minutes after shock until VF/ VT no longer present

Notes

• Other considerations:
• unconscious adults with return of spontaneous circulation after out-of- hospital cardiac arrest be cooled to 32 to 34 Celsius for 12 to 24 hours when the initial rhythm was ventricular fibrillation [2]

More General Terms

• emergency medicine
• cardioversion

Additional Terms

• 'quick-look' paddle
• protocol for manual defibrillators

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 238-40
2. ECC Committee, ECC Subcommittees, and ECC Task Forces; and Authors of Final Evidence Evaluation Worksheets 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care With Treatment Recommendations Conference. Circulation. 2005 Dec 13;112(24_suppl):b2-b5. No abstract available. PMID: [1]
3. ACLS - The Reference Texbook ACLS: Principles & Practice, Cummins RO et al (eds), American Heart Association, 2003 ISBN 0-87493-341-2

defibrillation (electrical cardioversion, automated external difibrillation, AED)