Defibrillation

aed asl defibrillation patient safety vf vt Mar 28, 2024
Early defibrillation significantly improves survival rates in cardiac arrest. 💥
 
Here’s what you need to know! 👇👇
 
Defibrillation of a shockable rhythm causes depolarisation of a large proportion of the myocardium, with the aim of enabling the resumption of organised electrical activity.
 
There are two shockable rhythms:
1️⃣ Ventricular Fibrillation (VF)
2️⃣ Pulseless Ventricular Tachycardia (VT)
 
In ALS, we refer to the use of a manual defibrillator instead of an AED, but what’s the difference?
 
Automated External Defibrillator (AED)
🔺Takes time to analyse rhythm
🔺Delivers a shock of predetermined size
🔺Appropriate to use initially in ALS if there is a delay in getting the manual defibrillator
 
Manual Defibrillator
🔺Requires visual rhythm analysis by a human
🔺Minimises time without compressions
🔺Has the ability to adjust energy delivered
🔺Generally have 3 modes
🔺External defibrillation
🔺Internal defibrillation
🔺Synchronised cardioversion
 
Energy setting
🔺Adult initial dose 200J
🔺Paediatric initial dose 4 J/kg
 
Pad placement
🔺Anterior - lateral (most common for adults)
🔺Anterior - posterior (most common for paeds and pacing)
🔺Bilateral axillary midline or left axillary midline and above right scapula (prone position)
🔺Considerations:
👉Pacemaker (at least 8cm away), jewellery, moisture, breast tissue, chest hair.
Pacing
👉Corrects unconscious bradycardia by using controlled pulses of electricity to increase rate.
 
Synchronised cardioversion
🔺Corrects fast and unstable rhythms by providing timed, low energy shocks at the peak of the ‘R’ wave of the ‘QRS’ complex.
 
Safety
🔺Caution with water, flammable substances and oxygen.
🔺Pads should be well adhered to the skin
🔺Compressions should stop during defibrillation
 
That’s defibrillation! Concerned about rhythm analysis in ALS? Keep an eye out for our Concept Series article on ALS Rhythm Interpretation and our Advanced Anaesthesia Live Series on Advanced Life Support. 😀
 
Build knowledge ✅
Improve safety ✅
 
Ref: https://www.anzcor.org/home/adult-advanced-life-support/guideline-11-4-electrical-therapy-for-adult-advanced-life-support/
 

 

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