Defibrillation, cardioversion and pacing

ACLS
Defibrillation
Cardioversion
Pacing

1. DEFIBRILLATION, CARDIOVERSION AND PACING By: dr ismah , A&E department 1

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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 7

8. Types 8 http://www.resuscitationcentral.com/ 360J 200J

9. 9 Sternum Apex

10. 10 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 13

14. Conditions Starting J (monophasic) AF 200 Atrial flutter 100 VT 200 SVT 100 14

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16. 16 Defibrillation Cardioversion

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18. P acing Unstable, bradyarrhythmias /bradycardia Symptomatic sinus bradycardia H eart block Complete heart block Mobitz type II 2 nd degree heart block Transcutaneous/ transvenous pacing 18

19. 1 st degree heart block Lengthened P-R interval > 0.2 sec (> 5 small boxes) Partial AV node block 19

20. 2 nd Degree Heart Block Mobitz Type I 2 nd degree AV block A cycle of progressive lengthening of PR interval followed by absence of QRS complex Wenkebach Phenomeno 20

21. * Mobitz Type II 2 nd Degree Heart Block Intermittent absence of QRS complex (non-conducted P wave) PR interval normal 21

22. *Complete/ 3 rd degree heart block Variable conduction origins Lack of synchronization between atria and ventricles 22

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25. Take home message Recognize ECG findings Indications for defibrillation, cardioversion and pacing How to do it 25

26. Thank you Ref: Tintinallis Emergency Medicine Manual, 7 th Edition AHA ACLS 2010; Electrical therapy Basic and Advanced Life Support 2005 by K.S.Chew , emergency department USM ECG Teaching by Dr Effa , cardiologist, Medical faculty UiTM http:// www.ecglibrary.com 26