therapuetic electricity

8/3/2019 Therapuetic Electricity

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Therapuetic Electricity

UHHS BMH Paramedic TrainingProgram

Ronald Pristera EMT-P


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Objectives

Understand the purpose and actions ofdefibrillation

Differentiate between defibrillation andcardioversion

Explain the proper procedure for

successfully defibrillating a patient


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What is therapeutic electricity?

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Defibrillation

Questions

What are we doing

when we defibrillate? What is the difference

between defib. &cardioversion?


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Defibrillation

TV Medicine

Not jump starting anything!

Worthless to defib flat line

Patients dont jump around like frogs when

you defibrillate them

Defibrillators are not weapons- you cant usethem to attack people


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Defibrillation

What is defibrillation?

Mechanism to overwhelm the chaotic

electrical activity that is present Depends on the intrinsic electrical conduction

system to take over after the ectopic activity

is suppressed.


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Who gets defib?


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Defibrillation

Principals of Defib.

DC counter shock- there is polarity!

Thoracic wall offers resistance to current flow Reduce resistance with

Proper paddle pressure

Conductive medium

Skin prep

Escalating energy levels


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Defibrillation

How can we reduce resistance?

25 pound of paddle pressure

Fully adhere combo pads- remove all air

Remove excess hair

Avoid transdermal patches

Avoid implanted devices


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Defibrillation

Pad or electrode placement

Sternal Apex

Anterior Posterior


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Defibrillation

Factors that affect sucessful defibrillation

Time

Time

Time

Hypoxia

Underlying medical issues What caused the arrest?

Chronic vs. Acute problems


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Defibrillation

Recognize Arrest/Rhythm !

VF check has become as important as ABCs

Defib has priority over beginning CPR/ALS

Escalating energy levels

200J, 300J then 360J

If sucessful at any level remain at that level Once @ full output stay there

Pediatric dose is 2J/kg or 1J/pound


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Defibrillation

Safety Considerations

A full output defib is about 4Kv @ 40A

Electricity is going to follow the path of leastresistance

Dont let that be you!

Perhaps use the mnemonic at the very leastlook all the way around the patient to ensureno contact with pt prior to defib


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Defibrillation

Develop SA What is the pt on

Is it conductive Water?

Wet grass/ground

Does everyone know you are about to defib?

Are there bystanders present who may be atrisk?

Atmosphere must not be flammable


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Defibrillation

More safety stuff

Dont discharge paddles into the air or

anything not designed for the load Inspect defib regularly

Learn the safety features of your device


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Defibrillation

AED vs. Manual

AEDs are becoming much more common

PAD programs Ancillary safety services

Should the Paramedic use the AED?


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AICDs

May feel shock if incontact with the victim

Protected fromexternal defib- butthey should befunction tested post

defib If VF persists- Rx as if

AICD was not there!


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AICDs

AICDs generally use epicardial patch

electrodes

If a 360 J defib is ineffective changepaddle placement (AP to SA)

AICDs can be deactivated by magnets.

Pts should avoid strong magnetic fields


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Defibrillation vs. Cardioversion

What's the difference?

Defib- patient must be pulseless

Cardioversion- designed to be synchronizedwith the R wave (during the absolute

refractory period)

Cardioversion is used to controltachydysrhymias


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Cardioversion

Indicated for

All tachycardias (>150) with serious

symptoms related to the tachycardia Tachycardias refractory to pharmacological

interventions


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Cardioversion

Slightly different than Defib

Same safety precautions

Same pad placement

Energy levels are lower

Not instantaneous- hold the fire buttons

until unit discharges Sedation may be indicated


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Cardioversion

Dosages

VT (with pulse), PSVT, A Fib/Flutter

100J, 200J, 300J, 360J

A Fib/Flutter may respond to 50J

Polymorphic VT

200J, 200-300J, 360J


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Cardioversion

Practice Pearls

CI for Poison/drug induced tachycardia

Must be connected to EKG leads as well asdefib paddles

Most units default after every cardioversion tothe defib mode


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Transcutaneous Pacing

Fixed or Demand rates

Preferred treatment for hemodynamically

unstable bradydysrhymias Be prepared to pace in the context of ACS

Class 2a intervention for symptomatic

idioventricular escape rhythyms


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Class 2a intervention to overdrive pacetachycardias refractory to drug therapy or

cardioversion Class 2b for bradyasystolic cardiac arrest-

pace early if at all!

Contraindicated in hypothermia orprolonged arrest


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Practice Pearls

Place pacer pads per directions

Must also have EKG cables (cant use combo) Set rate @ 80bpm

Increase current until capture then add 2ma

for safety (in bradycardias) For cardiac arrestbegin with full output then

decrease until capture is lost- add 2 ma


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Practice Pearls

Confirm mechanical capture- dont use carotid

pulse muscular contraction may mimic thepulse

Conscious pts may require sedation


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Internal Pacers

Different types

Ventricular

A-V sequential

Modern pacer spikes are hard to see

V1 is an excellent lead for spikes


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Misc Information

What is the leading cause of defib failure?

Learn how to properly maintain your

batteries Learn the normal operating parameters of

your defibrilator


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Final Motivation

What are the twointerventions incardiac arrest thathave been proven topositively affect ptoutcome?


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Questions? Comments

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