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Defib skillstation22122011edited
This document discusses defibrillation and provides guidance on its use. It defines defibrillation as terminating ventricular fibrillation for at least 5 seconds after a shock. Early defibrillation within the first few minutes of cardiac arrest is critical for survival. The document outlines the different types of defibrillators, including automated external defibrillators, manual defibrillators, and implanted defibrillators. It emphasizes the importance of proper defibrillator technique, such as using coupling agent, applying the appropriate paddle force and size, and ensuring paddles are held horizontally. Safety tips are also provided, like avoiding defibrillation over breast implants or medication patches due to risk of fire.
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- 1. DEFIBRILLATION ALS Subcommittee 2010
- 2. Cardiac Arrest Algorithm D– danger R – response S – shout A – airway B – breathing C – circulation D – defibrillation ALS Subcommittee 2010
- 3. Importance of Early Defibrillation • To give the victim the best chance of survival, 3 actions must occur within the first moments of a cardiac arrest: 1) Activation of the emergency medical services 2) Provision of CPR 3) Operation of a defibrillator AHA guidelines 2010.Section 6.Electrical therapies ALS Subcommittee 2010
- 4. Importance of Early Defibrillation ALS Subcommittee 2010
- 5. Why Defibrillate? • DoesNOT equal to resuscitation outcome • The goal is to RESTORE sinus rhythm ALS Subcommittee 2010
- 6. Shockable Rhythms VF VT ALS Subcommittee 2010
- 7. Definition of Defibrillation •Defined as the termination of VF for at least 5s after the shock – an electrophysiological event that occurs 30- 50ms after shock delivery; the heart is stunned and hopefully the SA Node will take over ALS Subcommittee 2010
- 8. Automated External Defibrillators ALS Subcommittee 2010
- 9. Manual Defibrillators ALS Subcommittee 2010
- 10. Automated Implanted Cardioverter Defibrillator (AICD) ALS Subcommittee 2010
- 11. Types of Defibrillatorsby Waveform • Monophasic • Biphasic ALS Subcommittee 2010
- 12. MONOPHASIC 360J 360J 77% - 91%* 54% - 63%* * First-shock efficacy ALS Subcommittee 2010
- 13. BIPHASIC 150-200J 120-200J 86%—98%* Up to 85% * * First-shock efficacy ALS Subcommittee 2010
- 14. IMPORTANT POINTS DURING DEFIBRILLATION ALS Subcommittee 2010
- 15. Important Points During Defibrillation • Hairy chest • Wet chest • Breasts • Patches Wrenn, K. The hazards of defibrillation through nitroglycerin patches. Ann Emerg Med 1990; 19(11): 1327-8 • AICD / pacemaker ALS Subcommittee 2010
- 16. Important Points During Defibrillation • Coupling agent – NO ARCING!! R. S. Hummel 3rd, J. P. Ornato, S. M. Weinberg and A. M. Clarke. Spark-generating properties of electrode gels used during defibrillation. A potential fire hazard. JAMA November 25, 1988; 260: 20 √ ALS Subcommittee 2010
- 17. Defibrillator Burn • Correctuse of coupling agent or defibrillator pads will prevent burns ALS Subcommittee 2010
- 18. Important Points During Defibrillation • Paddle force – 8kg in adult, 5kg in 1-8 year old children when using adult paddles • Paddle size – Minimum 150cm2, diameter 8-12cm ALS Subcommittee 2010
- 19. Important Points During Defibrillation • Paddle position 1. Sternal - apical 2. Biaxillary 3. Right or left upper back – apical 4. Antero-posterior especially in atrial arrhythmias • All 4 positions are equally effective in shock success Deakin CD, Sado DM, Petley GW, Clewlow F. Is the orientation of the apical defibrillation paddle of importance during manual external defibrillation? Resuscitation 2003;56:15—8 ALS Subcommittee 2010
- 20. Important Points During Defibrillation ALS Subcommittee 2010
- 21. Important Points During Defibrillation ALS Subcommittee 2010
- 22. Important Points During Defibrillation • Fire May be ignited by sparks from poorly applied defibrillator paddles in the presence of an oxygen-enriched atmosphere Miller, P. H. Potential fire hazard in defibrillation. JAMA 1972;221(2): 192. Early report of fire hazard during defibrillation Fires from Defibrillation during Oxygen Administration. Hazard. Health Devices Jul 1994;23(7):307-8 Robertshaw, H. and G. McAnulty. Ambient oxygen concentrations during simulated cardiopulmonary resuscitation. Anaesthesia 1998;53(7): 634-7 Theodorou et al. Fire Attributable to a Defibrillation Attempt in a Neonate. Pediatrics 2003;112:677-679 ALS Subcommittee 2010
- 23. Important Points During Defibrillation • One I clear, Two you clear, Three everybody clear • Look back at monitor before shocking • Paddles MUST be horizontal at all times! ALS Subcommittee 2010
- 24. What is wrongwith this picture? ALS Subcommittee 2010
- 25. How to defibrillate? stop look go 1. Attach electrodes to patient’s chest 2. Turn defibrillator on – select leads 3. Analyse the rhythm ?shockable 4. Apply coupling agent or pads to patient’s chest 5. Select energy level 6. Apply paddles to chest 7. Charge the paddles 8. The “Clear” chant 9. Check monitor again 10.Discharge shock and return paddles to machine ALS Subcommittee 2010
- 26. Synchronised Cardioversion • Forrhythms with an organised QRS complex and perfusing i.e. with a pulse but haemodynamically unstable – Shock delivery timed with the QRS complex • Low-energy shock of 50-200J • Indications: Supraventricular tachycardia Atrial flutter Atrial fibrillation Unstable monomorphic VT • Not effective in junctional tachycardia or multifocal atrial tachycardia ALS Subcommittee 2010
- 27. Defibrillation + CPR •Early defibrillation is critical to survival from sudden cardiac arrest because: 1. The most frequent initial rhythm in sudden cardiac arrest is VF 2. Rx for VF is defibrillation 3. Probability for successful defibrillation diminishes with time 4. VF tends to deteriorate to asystole within a few minutes ALS Subcommittee 2010
- 28. If Flatline… • Alwaysdouble check that it IS a flatline – Check other leads – Check attachment of leads – Increase the size of rhythm to rule out fine ventricular fibrillation ALS Subcommittee 2010
- 29. SUMMARY • Definition • Typesof defibrillator • Tips for defibrillation – Hairy chest – Wet chest – Breast – Patches – AICD / pacemaker – Coupling agent – Paddle force, paddle size, paddle position – Fire ALS Subcommittee 2010
- 30. References 1. American HeartAssociation CPR Guidelines Nov 2010 2. European Resuscitation Council Guidelines for Resuscitation 2010 3. Ibrahim WH. Recent advances and controversies in adult cardiopulmonary resuscitation. Postgrad Med J 2007;83:649-54 ALS Subcommittee 2010
- 31. THANK YOU NATIONAL COMMITTEEON RESUSCITATION TRAINING SUBCOMMITEE FOR ADVANCED LIFE SUPPORT Dr Tan Cheng Cheng Dr Luah Lean Wah Dr Ismail Tan bin Mohd Ali Tan Dr Wan Nasrudin bin Wan Ismail Dr Chong Yoon Sin Dr Priya Gill Dr Ridzuan bin Dato’ Mohd Isa Dr Thohiroh binti Abdul Razak Dr Adi bin Osman ALS Subcommittee 2010