Defibrillation & Cardioversion

1. Defibrillation & Cardioversion Prepaired By : St. Malak Salhap St. Jameela Asbeh

2. Definition of Cardioversion Cardioversion is a method to restore a rapid heart beat back to normal . Cardioversion is used in persons who have heart rhythm problems (arrhythmias), which can cause the heart to beat too fast.

4. Cardioversion Most elective or non-emergency Cardioversions are performed : • To treat atrial fibrillation or atrial flutter to regain heart rhythm. • To treat disturbances originating in the upper Chambers (atria) of the heart.

5. Cardioversion Cardioversion is used in emergency situations to correct a rapid abnormal rhythm associated with faintness, low blood pressure, chest pain, difficulty breathing, or loss of consciousness.

6. Types Of Cardioversion Cardioversion can be "chemical" or "electrical". • Chemical cardioversion: refers to the use of antiarrhythmia medications to restore the heart's normal rhythm.

7. Types Of Cardioversion Electrical cardioversion : (also known as " direct-current" or DC cardioversion); is a procedure whereby a synchronized electrical shock is delivered through the chest wall to the heart through special electrodes or paddles that are applied to the skin of the chest and back.

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9. The goals of the electrical cardioversion • Is to disrupt the abnormal electrical circuit(s) in the heart. • To restore a normal heart beat .

10. Pharmacologic Cardioversion Cardioversion can be done using drugs that are taken by mouth or given through an intravenous line (IV). It can take several minutes to days for a successful cardioversion.

11. Pharmacologic Cardioversion • If pharmacological cardioversion is done in a hospital, your heart rate will be regularly checked. • Cardioversion using drugs can be done outside the hospital, but this requires close follow-up with a cardiologist.

12. Pharmacologic Cardioversion Blood thining medicines may be given with electrical cardioversion to prevent clots from moving to the heart.

13. Complications Possible complications of cardioversion are uncommon but may include: • Worsening of the arrhythmias . • Blood clots that can cause a stroke or other organ damage, bruising, burning or pain where the paddles were used. • Allergic reactions from medicines used in pharmacologic cardioversion .

14. Equipment • Defibrillator with a synchronising button. • Emergency trolley with emergency drugs; ( lignocaine, atropine, and adrenaline ). • Oxygen mask, intubation equipment, airway . • Monitor and continuous recording facilities.

15. Preparing for a Cardioversion • Do not eat or drink for at least eight hours prior to the procedure. • Take your regularly scheduled medications the morning of the procedure unless your medical practitioner has told you otherwise . • Bring a list of all your medications with you.

16. Preparing for a Cardioversion • Do not apply any lotions or ointments to chest or back as this may interfere with the adhesiveness of the shocking pads. • Do not drive yourself home after receiving sedation anesthesia.

17. Preparing for a Cardioversion • Do not operate a car, heavy machinery, or make any important decisions. • Stop digoxin before 48 hours prior the procedure. • Apply ointment to the area to reduce the discomfort.

18. Outcome The procedure will be terminated either by a successful reversion to sinus rhythm or when the medical officer determines that cardioversion will not revert the rhythm.

19. Defibrillation Is a medical technique used to counter the onset of ventricular fibrillation, a common cause of cardiac arrest, and pulseless ventricular tachycardia, In simple terms, the process uses an electric shock to stop the heart arrhythmias, in the hope that the heart will restart with rhythmic contractions.

20. History Of Defibrillation Defibrillation was invented in 1899 by Prevost and Batelli, two Italian physiologists. They discovered that electric shocks could convert ventricular fibrillation to sinus rhythm in dogs. The first case of a human life saved by defibrillation was reported by Beck in 1947.

21. The Purpose Of Defibrillation Is to apply a controlled electrical shock to the heart, which leads to depolarization of the entire electrical conductive system of the heart.

22. Types of Defibrillators InternalDefibrillators The device may be implanted directly in the user of the device. So it is known as an Impalantable cardioverter-defibrillator or (much less frequently) an internal cardiac defibrillator (ICD). This type of defibrillator is designed to provide immediate defibrillation to high-risk patients .

23. Implantable Cardioversion Defibrillation An implantable cardioverter-defibrillator (often called an ICD) is a device that briefly passes an electric current through the heart. It is "implanted," or put in your body surgically. It includes a pulse generator and one or more leads. The pulse generator constantly watches your heartbeat.

24. Types of Defibrillators Automated External defibrillator (AEDs) External defibrillators are typically used in hospitals or ambulances, but are increasingly common outside the medical areas . As automated external defibrillators become safer and cheaper.

25. Methods Of Defibrillation The shock is generally conducted through the heart by two electrodes, in the form of two hand-held paddles or adhesive patches depending on the variety of the defibrillator.

26. Methods Of Defibrillation • One electrode is placed on the right side of the front of the chest just below the clavicle. • The other electrode is placed on the left side of the chest just below the pectoral muscle of breast.

28. Methods Of Defibrillation Open-chest defibrillators also exist, which have electrodes in the form of two cup-shaped paddles that surround the sides of the heart and shock it directly. Open-chest defibrillators generally require less energy to operate due to direct contact with the heart .

29. Methods Of Defibrillation The number of attempts is in practice limited to a series of three or four attempts at increasing energies. The likelihood of restoring normal heart rhythm is much less in successive attempts.

32. Differences Between Cardioversion & Defibrillation • One major difference between cardioversion and defibrillation with the timing of the delivery of electrical current . • Another major difference concerns the circumstance defibrillation usually performed as an emergency treatment . • Cardioversion is usually, but not always a planned procedure .

33. Procedure The most well-known type of electrode is the traditional metal paddle with an insulated handle. This type must be held in place on the patient's skin while a shock or a series of shocks is delivered.

34. ProcedureSteps • Place paddles so that they do not touch pts clothing or bed linens or not near direct oxygen supply. • Ensure monitor is attached to pat. • Do not charge the machine untill ready to shock.

35. Procedure • Exert 25 pound pressure on the paddle . • Ensure you and every body is free of the pat.Inspect skin for burns. • Record the delivered energy.

37. Treatment Shock may be delivered, but it is not regarded as the treatment of choice. Antiarrhthmic medications such as amiodarone, cordorone, lidocaine, magnesium, or pronestly are given if ventricular dysrhythmia persists.

38. Treatment The probability of a successful conversion is very small according to the current guidelines, in this situation, continued CPR in order to improve the oxygenation of the heart for a few minutes is preferred before defibrillation is attempted . .

39. Warning As the nurse applies the shock this is just a warning to everyone around to stay away from the patient for risk of electrical shock.

40. THANK YOU