Defibrillator.pptx

A defibrillator is a medical device designed to deliver a therapeutic dose of electrical energy to the heart in order to treat life-threatening cardiac dysrhythmias, particularly ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). Its primary function is to restore a normal heartbeat by stopping or correcting an arrhythmia, which is an irregular heartbeat.

1. defibrillator Ms. Sonam sharma Asst. professor

2. A defibrillator is a medical device used to treat life-threatening cardiac arrhythmias, particularly ventricular fibrillation (VF) and ventricular tachycardia (VT). These conditions occur when the heart's electrical activity becomes chaotic, causing it to stop effectively pumping blood. Defibrillators deliver a dose of electric current (a shock) to the heart. This shock depolarizes a critical mass of the heart muscle, terminates the arrhythmia, and allows the heart's natural pacemaker to re-establish an effective rhythm.

3. Types of Defibrillators

4. 1. Automated External Defibrillators (AEDs): Usage: Designed for use by laypersons with minimal training. Found in public places like airports, schools, and sports venues. Features: Automatically diagnose the cardiac arrhythmia and determine if a shock is needed. Provide voice and visual prompts to guide the user through the process.

5. 2. Manual Defibrillators: Usage: Operated by healthcare professionals with specialized training. Used in hospitals and by emergency medical services. Features: Require the operator to manually interpret the patient's heart rhythm and decide the voltage and timing of the shock.

6. 3. Implantable Cardioverter Defibrillators (ICDs): Usage: Surgically implanted in patients at high risk of recurrent, sustained ventricular tachycardia or fibrillation. Features: Continuously monitor the heart rhythm and automatically deliver shocks or pacing to correct arrhythmias.

7. 4. Wearable Cardioverter Defibrillators (WCDs): Usage: Worn by patients at temporary risk of sudden cardiac arrest who are not candidates for an ICD. Features: Non-invasive, monitors the heart continuously, and delivers a shock if a life-threatening rhythm is detected.

8. Indications for Use Sudden Cardiac Arrest (SCA): Immediate use of a defibrillator can significantly improve survival rates. Ventricular Fibrillation (VF): Characterized by disorganized electrical activity causing the heart to quiver instead of pump. Ventricular Tachycardia (VT): A fast but regular heart rhythm that can deteriorate into VF if untreated.

9. contraindication 1. Non- Shockable Rhythms Defibrillators are not effective for all types of cardiac arrhythmias. Specifically, they should not be used for: Asystole : This is a flatline ECG where there is no electrical activity in the heart. Pulseless Electrical Activity (PEA) : This is where there is electrical activity on the ECG but no corresponding pulse or effective cardiac output .

10. 2. Conscious Patients Defibrillators should not be used on conscious patients with a pulse, as the high-energy shock can cause significant pain and potential injury. These devices are intended for use in cases of cardiac arrest where the patient is unresponsive and without a pulse. 3. Presence of Flammable Materials Avoid using a defibrillator in an environment where there are flammable gases or liquids, such as in an operating room where certain anesthetics are used, or in the presence of oxygen-rich atmospheres, which could ignite .

11. 4. Wet Environments While modern defibrillators are designed to be somewhat water-resistant, using a defibrillator on a wet patient or in a wet environment can be dangerous and potentially ineffective. Ensure the patient’s chest is dry before applying the defibrillator pads. 5. Metal Surfaces Care should be taken when using a defibrillator on a patient who is in direct contact with metal surfaces. The metal can conduct electricity and potentially harm others in contact with it. Place a non-conductive barrier under the patient if possible .

12. 6. Implantable Devices Patients with implantable devices like pacemakers or implantable cardioverter -defibrillators (ICDs) require special consideration: Pacemakers : Avoid placing the defibrillator pads directly over the pacemaker to prevent damage to the device. ICDs : Be aware that the ICD may attempt to deliver its own shock. Coordination and careful monitoring are needed in such cases. 7. Medication Patches Remove any transdermal medication patches (such as nitroglycerin patches) from the patient’s chest to avoid burns and ensure effective pad contact .

13. Standard Pad Placement for Adults Upper Right Chest: Place the first pad on the patient's upper right chest, just below the collarbone (clavicle) and to the right of the breastbone (sternum). Lower Left Chest: Place the second pad on the patient's lower left side, a few inches below the armpit. The pad should be positioned to the left of the nipple and above the waistline.

14. Pad Placement for Children and Infants Front-Back Method (Preferred for small children and infants): Front Pad: Place one pad in the center of the chest, directly over the sternum. Back Pad: Place the second pad on the back, between the shoulder blades. Adult Pad Placement (For children over 8 years old or if pediatric pads are unavailable): Use the same placement as for adults, ensuring the pads do not touch each other.

15. Preparation of the Patient Assessment : Confirm the indication for defibrillation. Check for signs of cardiac arrest and ensure CPR is ongoing if needed. Positioning : The patient should be on a firm, flat surface. If the patient is on a bed, consider moving them to the floor or using a backboard. Remove Clothing : Expose the patient's chest. Remove any clothing, jewelry, or other items that might interfere with pad placement. Clean the Skin : Dry the patient's chest if it's wet. Shave excessive chest hair if it obstructs pad adhesion. Medication Patches : Remove any transdermal medication patches from the chest area to avoid burns and ensure proper pad contact .

16. Procedure to Attach the Defibrillator 1. Select and Place Pads/Paddles : Pads : For AEDs and some manual defibrillators, use adhesive pads. Placement : Anterior-Posterior : One pad on the right upper chest (below the collarbone) and the other on the left side of the chest (over the ribs). Anterolateral : One pad on the right upper chest (below the collarbone) and the other on the left lower chest (below the armpit ).

17. Paddles : For manual defibrillators, use conductive gel on paddles . Placement : Place one paddle on the right upper chest and the other on the left lower chest, ensuring good contact with the skin . 2. Connect Pads to Defibrillator : Ensure the pads or paddles are properly connected to the defibrillator unit . 3. Set the Device : For manual defibrillators, set the appropriate energy level based on patient size and the clinical scenario. Common initial settings are 120-200 joules for biphasic devices and 360 joules for monophasic devices .

18. Monophasic defibrillation: A monophasic defibrillator delivers a single, unidirectional shock to the heart. The electrical current flows in one direction from one electrode to the other. Monophasic defibrillators were the first type of defibrillators developed and were commonly used before the advent of biphasic defibrillators . Biphasic Defibrillator: A biphasic defibrillator delivers an electric shock to the heart in two phases: the current first flows in one direction and then reverses. This bidirectional flow improves the efficiency of the shock and reduces the energy required to achieve defibrillation compared to monophasic defibrillators .

19. 4. Analyze Rhythm : AED : The device will automatically analyze the heart rhythm and advise if a shock is needed. Manual : You will need to interpret the rhythm on the monitor . 5. Clear the Area : Announce "CLEAR" and ensure no one is in contact with the patient or the bed. 6. Deliver the Shock : Press the shock button on the defibrillator. For manual defibrillators with paddles, press the buttons on the paddles simultaneously .

20. 7. Post-Shock : Immediately resume CPR for 2 minutes before reassessing the rhythm and pulse. Repeat defibrillation as needed based on rhythm analysis and clinical response .

21. Nurse’s Role in Defibrillator Use

22. 1. Preparation Assessment : Quickly assess the patient's condition to determine the need for defibrillation. Look for signs of cardiac arrest, such as the absence of a pulse and unresponsiveness. Ensure Equipment Readiness : Verify that the defibrillator is functional, charged, and has all necessary accessories like pads or paddles readily available. Patient Preparation : Expose the Chest : Remove clothing and jewelry to provide a clear area for pad or paddle placement. Clean the Skin : Dry the chest if it is wet and shave excessive chest hair to ensure proper pad adhesion. Remove Medication Patches : Take off any transdermal medication patches to avoid burns and ensure proper pad contact .

23. 2. Operation Pad/Paddle Placement : For Adult Patients : Place the pads or paddles correctly according to the defibrillator type (anterior-posterior or anterolateral). For Pediatric Patients : Use the appropriate pad size and placement specific to children and infants. Safety Precautions : Ensure no one is in contact with the patient or bed during shock delivery. Clearly announce "CLEAR" before delivering the shock to prevent accidental shocks to others .

24. Device Operation : AED (Automated External Defibrillator) : Follow the voice prompts provided by the AED. Ensure the pads are correctly placed and connected. Allow the AED to analyze the heart rhythm and follow the instructions to deliver a shock if advised. Manual Defibrillator : Select the appropriate energy level based on patient size and clinical scenario. Charge the defibrillator and deliver the shock by pressing the discharge buttons.

25. 3. Post-Defibrillation Care Immediate Response : After delivering the shock, immediately resume CPR if needed, according to the latest resuscitation guidelines. Monitoring : Continuously monitor the patient's heart rhythm and vital signs. Be prepared to repeat defibrillation if necessary. Documentation : Accurately document the event, including the time of defibrillation, energy levels used, patient response, and any complications encountered. Post-Event Care : Provide ongoing care, including managing the patient’s airway, breathing, and circulation. Prepare the patient for transfer to an intensive care unit (ICU) or appropriate medical facility if needed .