Defibrillator

DEFIBRILLATOR
INTRODUCTION
Defibrillator is an electronic device which send shocks and is used

to correct heart conduction abnormalities. In 1956, alternating
current(AC) and 1962, direct current (DC) was first introduced among
humans to treat ventricular fibrillation. Sino atrial node atrioventricular
node plays a major role in the conduction system of heart. SA node is
the normal pacemaker of the heart. When it develops abnormal
conduction, ECG shows arrhythmias. Then to correct the conducting
pathway we provide electrical shocks using defibrillators. This is called
defibrillation.
DEFINITION
Defibrillation is a process in which an electronic device sends an electric

shock to the heart to stop an extremely rapid, irregular heart beat and
restore normal heart rhythm .
(Brunner & Suddharth)
It is accomplished by the passage of a DC electric shock through heart

that is sufficient to depolarize cells of myocardium.
(Lewis)
It involves delivering a high intensity electrical charge inorder to
depolarize the entire myocardium at one time so that the fastest
normal pacemaker can regain control of pacing function of heart
(Coronary Care Nursing)
INDICATIONS
1) Ventricular fibrillation:
Condition in which individual muscle fibres of heart contract

independently in a spasmodic and incoordinated manner, giving it a
quivering appearance.
2) Pulseless ventricular tachycardia
3) Cardiac arrest or asystole
TYPES
 Monophasic
 Biphasic
1) Monophasic defibrillators
Deliver energy in one direction.
2) Bipasic defibrillators
Deliver energy in two directions. Deliver successful shocks at
lower energies & with fewer post shock ECG abnormalities than
Monophasic defibrillators.
Output of a defibrillator
Measured in joules. Recommended energy for biphasic defibrillator

to deliver the first & successive shocks using 150-200 joules.
Monophasic: Initial shock at 360 joules.
PARTS OF A DEFIBRILLATOR
On off switch, output dial(100- 400 J/ watts per second), intensity

meter, paddles, synchronizing knob( used in cardioversion), monitor
system and ECG print out, battery or AC knob( for charging).
PROCEDURE
PREPARATION OF PATIENT
 Take ECG recordings.

 Explain the procedure to patient and relatives
 Obtain a written consent.
 Establish an IV line, monitor vitals signs.
 Keep resuscitation tray and articles ready.
 Stop digitalis intake on the morning of procedure date as it
may induce ventricular arrythymias.
 Quinidine may be given for several days prior to
cardioversion in order to increase effect. Patient remaining
in sinus rhythm after cardioversion.
 Lidocaine is kept ready to treat ventricle arrhythmias
 Short term anesthesia
 Disconnect all electrical equipments.
 Keep all personnel away from patient to protect them from
getting a shock.
PROCEDURE
 CPR should be in progress until defibrillator is available

 Defib should be turned on and proper energy level should be
selected.
 Synchronizer switch is turned off
 Conductive meterials (eg: defib gel pads) applied to chest one to
the right of sternum just below clavicle (II & III ICS) & other to left
of apex (5th ICS)
 Defib is charged by a button on defib or paddles
 Paddles are placed on chest wall over conductive material.
 Operator calls’ I clear,’ ‘you clear’, ‘all clear’ and press the button
on both paddles simultaneously.
 Resume CPR.
 It desired cardiac rhythm is not restored, repeat with high energy
level.
AUTOMATIC EXTERNAL DEFIBRILLATOR
Have rhythm detection capacity & ability to advice operator to

deliver a shock using hand-free defib pads. It is too costly.
SYNCHRONIZED CARDIOVERSION
Elective cardioversion or synchronized cardioversion (commonly

called cardioversion) is planned procedure in which the electric current
is programmed to discharge synchronized with QRS complex (peak of
wave). By using synchronization, one avoids shocking the heart in the
vulnerable period of heart ( T Wave)which cause VF.
IMPLANTABLE--CARDIOVERTER DEFIBRILLATOR ( ICD)
This is an important technology for patients who
 Have survived sudden cardiac death.

 Have spontaneous sustained ventricular tachycardia.
 Have syncope with inducible VT/ VF during electrophysiologic
studies.
It consist of a lead system placed via subclavian vein to endocardium,
battery powered pulse generator, ICD sensing system.
DIFFERENCE BETWEEN DEFIBRILLATION AND CARDIOVERSION
Defibrillation Cardioversion
-emergency procedure - planned/ elective procedure
-designed to treat lethal -treat less serious arrhythmias
arrythymias. Eg: VF, pulseless VT -patient is conscious.
-patient is usually unconscious, no -Small energy level 50- 100J
sedation needed. -synchronized switch is in ‘ON’
-Large energy level such as 200- position.
400 J -a well-defined R wave should be
-synchronized switch is in ‘OFF’ identified on ECG strip to deliver a
position. synchronized shock at the proper
-configuration of ECG waves not time.
well defined.
COMPLICATIONS
 Damage to myocardium due to repeated high energy

electrical shock.
 Chest burns (poor contact between paddles & skin)
 Electrocution of bystander
 Formation of short circuit between paddles due to excess
conduction jelly.
NURSING DIAGNOSIS
Pre procedure
 Decreased cardiac output related to impaired cardiac function as

manifested by tachyarrhythmias, low BP, syncope, altered LOC.
 Ineffective cardiac tissue perfusion related to decreased coronary
blood flow as manifested by increased heart rate, low blood
pressure.
Post procedure
 Risk for complications related to damage to myocardium.

 Risk for injury
 Risk for burns

Defibrillator

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DEFIBRILLATOR

Defibrillator is an electronic device which send shocks and is used

Defibrillation is a process in which an electronic device sends an electric

(Brunner & Suddharth)

It is accomplished by the passage of a DC electric shock through heart

(Coronary Care Nursing)

Condition in which individual muscle fibres of heart contract

2) Pulseless ventricular tachycardia

3) Cardiac arrest or asystole

Deliver energy in one direction.

Measured in joules. Recommended energy for biphasic defibrillator

Monophasic: Initial shock at 360 joules.

On off switch, output dial(100- 400 J/ watts per second), intensity

 Take ECG recordings.

 CPR should be in progress until defibrillator is available

AUTOMATIC EXTERNAL DEFIBRILLATOR

Have rhythm detection capacity & ability to advice operator to

Elective cardioversion or synchronized cardioversion (commonly

IMPLANTABLE--CARDIOVERTER DEFIBRILLATOR ( ICD)

This is an important technology for patients who

 Have survived sudden cardiac death.

DIFFERENCE BETWEEN DEFIBRILLATION AND CARDIOVERSION

 Damage to myocardium due to repeated high energy

 Decreased cardiac output related to impaired cardiac function as

 Risk for complications related to damage to myocardium.

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