This document discusses defibrillation, cardioversion, and pacing. It provides: 1) A brief history of defibrillation and its use for ventricular fibrillation and pulseless ventricular tachycardia. 2) An overview of cardioversion for treating unstable tachyarrhythmias with signs of low cardiac output, excessive heart rates, or chest pain. Synchronized cardioversion times shock delivery to the QRS complex. 3) Information on pacing for unstable bradyarrhythmias and symptomatic bradycardia, including complete heart block and Mobitz type II second-degree heart block.

1. DEFIBRILLATION,
CARDIOVERSION AND
PACING
By: dr ismah, A&E department
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7. Defibrillation
History
1900 defibrillation discovery
1947 human defibrillation
1967 successful outside hospital defibrillation
For VF or pulseless VT
Defibrillation (shock success)  termination of
VF for at least 5s following shock
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8. Types
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http://www.resuscitationcentral.com/
360J 200J

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Sternum
Apex

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Automated AED @ KLIA

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13. Cardioversion
Alive, unstable, tachyarrhythmia
Unstable?
- Signs of low cardiac output: systolic hypotension
< 90 mmHg, altered mental status
- Excessive rates >150/min
- Chest pain
- Heart failure
Synchronized cardioversion is shock
delivery that is timed (synchronized) with
the QRS complex
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14. Conditions Starting J
(monophasic)
AF 200
Atrial flutter 100
VT 200
SVT 100
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Defibrillation Cardioversion

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18. Pacing
Unstable, bradyarrhythmias/bradycardia
Symptomatic sinus bradycardia
Heart block
- Complete heart block
- Mobitz type II 2nd degree heart block
Transcutaneous/transvenous pacing
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19. 1st degree heart block
Lengthened P-R interval > 0.2 sec (> 5 small
boxes)
Partial AV node block
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20. 2nd Degree Heart Block
Mobitz Type I 2nd degree AV block
A cycle of progressive lengthening of PR
interval followed by absence of QRS complex
Wenkebach Phenomeno
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21. *Mobitz Type II 2nd Degree Heart Block
Intermittent absence of QRS complex
(non-conducted P wave)
PR interval normal
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22. *Complete/ 3rd degree heart block
Variable conduction origins
Lack of synchronization between atria and
ventricles
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25. Take home message
Recognize ECG findings
Indications for defibrillation, cardioversion and
pacing
How to do it
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26. Thank you
Ref:
1. Tintinallis Emergency Medicine Manual, 7th Edition
2. AHA ACLS 2010; Electrical therapy
3. Basic and Advanced Life Support 2005 by K.S.Chew,
emergency department USM
4. ECG Teaching by Dr Effa, cardiologist, Medical faculty
UiTM
5. http://www.ecglibrary.com
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