defibrillation and cardioversion

7/18/2019 Defibrillation and Cardioversion

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DEFIBRILLATION

AND

CARDIOVERSION

MRS. CHINJU CYRIL

TRAINEE CLINICA L INSTRUCTOR



Objectives At the end of this session, the ttendees !i"" be b"e to#

$. %efine c&diove&sion nd defib&i""tion

'. Stte the (o"s). En*+e&te the indictions nd cont&indictions

. E-"in the +echnis+

/. List do!n the t0es of defib&i""to&s

1. %esc&ibe the &oced*&e

2. En"ist the co+"ictions



DEFINITIONThe therapeutic use of controlled electric

current over a brief period of time.

Contd…



DEFINITIONDefibrillation is the non-synchronized

delivery of energy during any phase of the

cardiac cycle.

Cardioversion is the delivery of energy that

is synchronized to the large R waves or QR

comple!.



ANATOMY AND

PHYSIOLOGY



ELECTRICAL ACTIVITY

OF HEART AND ECG



3h0 S0nch&oni4tion5S0nch&oni4tion voids the de"ive&0 of "o!

ene&(0 shoc6 d*&in( c&dic &eo"&i4tion 7t8!ve9.

If the shoc6 occ*&s d*&in( &eo"&i4tion, the&e is

hi(h "i6e"ihood tht the shoc6 cn &eciitte :;.



HISTORY<&evost nd =te"i 7$>th cent*&09 e&fo&+ed shoc6

e-e&i+ents on the he&ts of do(s.

C"*de =ec6 fi&st *sed this techni?*e in h*+ns.

=e&n&d Lo!n 7$@/@9 desi(ned +ode&n d0

+onohsic defib&i""to&.



GOALS OF CARDIOVERSION &

DEFIBRILLATION

To dis&*t the

bno&+"

e"ect&ic" ci&c*its

in the he&t.To &esto&e no&+"

he&t bet.



CARDIOVERSION



INDICATIONS

Supraventricuartac!"car#ia

Atria$i%riatin

Atria$utter

Ventricuartac!"car#ia



CONTRAINDICATIONS%0s&h0th+is d*e to enhnced *to+ticit0

7di(it"is to-icit0 nd ctecho"+ine8ind*ced

&&h0th+i9

M*"tifoc" t&i" tch0c&di



DEFIBRILLATION



INDICATIONS

Pu'ee'' ventricuar tac!"car#ia (VT)

Ventricuar $i%riatin (VF)



CONTRAINDICATIONS

A!6e, &esonsive tients

An0 &&h0th+is !ith *"se



MECHANISM The de"ive&ed shoc6 c*ses e"ect&ic c*&&ent to (o f&o+ the

ne(tive to the ositive e"ect&ode of the defib&i""to&,

ssin( the he&t on its !0.

It c*ses "" the he&t ce""s to cont&ct si+*"tneo*s"0,

the&eb0 inte&&*tin( nd te&+intin( the bno&+"

e"ect&ic" &h0th+ nd th*s ""o!in( the sin*s node to

&es*+e no&+" ce+6e& ctivit0.



TYPES OF

DEFIBRILLATORS

Ene&(08 bsed

defib&i""to&s

I+ednce8

bseddefib&i""to&s

C*&&ent8bseddefib&i""to&s



Ener*"+%a'e# #e$i%riatr' The device ch&(es ccito& to se"ected

vo"t(e nd then de"ive&s &e8secified

+o*nt of ene&(0 in jo*"es.



I,pe#ance+%a'e# #e$i%riatr'A""o! se"ection of the c*&&ent "ied bsed

*on the t&nstho&cic i+ednce 7TTI9.



Tran't!racic I,pe#anceResistnce to the c*&&ent f"o!

If t&nstho&cic i+ednce is hi(h, "o!ene&(0 shoc6 +0 fi" to ss eno*(h c*&&ent

th&o*(h the he&t to chieve defib&i""tion.



I,pe#ance+%a'e# #e$i%riatr'TTI is ssessed initi""0 !ith test *"se nd

s*bse?*ent"0 the ccito& ch&(es to the

&o&ite vo"t(e.



Current+%a'e# #e$i%riatr'A fi-ed dose of c*&&ent is de"ive&ed, &es*"ts

in defib&i""tion th&esho"ds tht &e indeendent

of t&nstho&cic i+ednce nd &e inv&intfo& the individ*".



TYPES OF

DEFIBRILLATORSMn*" e-te&n" defib&i""to&

Mn*" inte&n" defib&i""to&

Se+i8 *to+ted e-te&n" defib&i""to&s

A*to+ted e-te&n" defib&i""to&s

I+"ntb"e c&diove&te&8defib&i""to&

3e&b"e c&dic defib&i""to&



Aut,ate# e-terna

#e$i%riatr' (AED)



Manua e-terna

#e$i%riatrC"sses of disch&(e !vefo&+

Monohsic *"se o& !vefo&+

=ihsic *"se o& !vefo&+



.!" %ip!a'ic i' pre$erre#/A +onohsic t0e, (ive hi(h8ene&(0 shoc6, * to

)1 to jo*"es d*e to !hich inc&esed c&dic inj*&0

nd in b*&ns the chest &o*nd the shoc6 d sites.

A bihsic t0e, (ive t!o se?*enti" "o!e& ene&(0

shoc6s of $' 8 ' jo*"es, !ith ech shoc6 +ovin( in

n oosite o"&it0 bet!een the ds.



TYPES OF DEFIBRILLATOR

ELECTRODESSoon shed

<dd"e t0e

<d t0e



SI0E OF PADDLESAd*"t si4e 7$8$)c+ di+ete&9

<edit&ic si4e 7 ./ c+ di+ete&9 fo&

tient !ei(ht B $ 6(.

Chi"d&en $ 6( D > c+.

Contd



SI0E OF PADDLESS+"" dd"es D concent&te c*&&ent, b*&ns he&t.

L&(e dd"es D &ed*ces c*&&ent densit0.

In edit&ic tient ens*&e ) c+ distnce bet!een

ds.



PADDLE PLACEMENTANTEROLATERAL ANTERO<OSTERIOR



E21IPMENTS

%efib&i""to&s !ith dd"e o& dhesive tch

Cond*ctive (e"

C&sh C&t !ith e+e&(enc0 d&*(s

Sedtives

Int*btion set

S*ction &t*s F cthete&s



PRERE21ISITES FOR

CARDIOVERSIONE-"in the &oced*&e

Obtin Info&+ed consent

Mintin N<O fo& 81 ho*&s &io& to e"ective

c&diove&sion

%i(it"is is *s*""0 discontin*ed '8)1 ho*&s &io&

c&diove&sion

Contd…



PRERE21ISITES FOR

CARDIOVERSIONChec6 defib&i""to& &io& to *se

C&sh c&t sho*"d be &ed0

Obtin $' "ed ECG

Chec6 se&*+ "eve"

Re+ove dent*&es je!e""e&ies

Contd…



PRERE21ISITES FOR

CARDIOVERSIONE+t0 b"dde&

Ens*&e tent I: cnn*"

Anesthetic (ents nd o-0(en to +intin i&!0

!ith ind*ced *nconscio*sness.

TEE is *s*""0 done to &*"e o*t bsence of e+bo"i in

he&t.



PROCED1RE



S!c3 ener*" +

De$i%riatin=ihsic # $' D ' J initi""0. Second nd

s*bse?*ent doses sho*"d be e?*iv"ent o& hi(he&

dose +0 be conside&ed.

Monohsic # )1 J



S!c3 ener*" + Car#iver'in N&&o! &e(*"& # / D $ J

N&&o! i&&e(*"& # $' D ' J bihsic

' J +onohsic

3ide &e(*"& # $ J

OS OC



POST PROCED1RECARE

Monito& the tient c"ose"0

Ens*&e tent i&!0.

Chec6 nd &eco&d vit"s

Obtin $' "ed ECG

Reco&d jo*"es d+iniste&ed, n*+be& of shoc6s,

&es*"t of defib&i""tionc&diove&sionReco&d n0 &e8+edictions (iven

Contd



POST PROCED1RE

CAREReco&d condition of s6in

<&ovide contin*o*s O'

Ad+iniste& nti&&h0th+ics s e& o&de&

O&" f"*ids cn be st&ted fte& ' h&s

C&e of defib&i""to&



COMPLICATIONS A&&h0th+is 7&e+t*&e bets9

:ent&ic*"& ;ib&i""tion

Th&o+boe+bo"i4tion

M0oc&di" nec&osis

<*"+on&0 ede+

S6in b*&ns



K*i4 $. <tient in ICU !s fo*nd *n&esonsive !ith

+onito& sho!in( f"t "ine ECG. 3hich of the

fo""o!in( !o*"d 0o* conside& in his +n(e+ent#

9 <&e&e fo& C&diove&sion

b9 I++edite"0 %efib&i""te

c9 %o not tte+t C&diove&sion o& %efib&i""tion



K*i4 '. A tient !s e-e&iencin( "ittions !ith =< $''21 ++ of

H( nd he&t &te of $>+in. ECG sho!ed Mono+o&hic :T.

;e! +in*tes "te& =< d&oed to 2 ++ of H( ssocited !ith

chest in. 3hich t&et+ent is "i6e"0 to be (iven5

9 S0nch&oni4ed shoc6

b9 Non8S0nch&oni4ed shoc6



K*i4 ). 3hich of the fo""o!in( c&dic &h0th+s &e

indicted fo& defib&i""tion5

9 :ent&ic*"& fib&i""tion

b9 <*"se"ess e"ect&ic" ctivit0

c9 <*"se"ess :T

defibrillation and cardioversion

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