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In the name of God

Learn about the differences between defibrillation and cardioversion, their indications, contraindications, equipment required, positioning techniques, waveform types, dosages, complications, and special considerations in emergency settings.

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In the name of God

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  1. In the name of God

  2. DC SHOCK دکتر علیرضا اسماعیلی استاد یارطب اورژانس

  3. Defibrillation is a nonsynchronized delivery of energy during any phase of the cardiac cycle

  4. cardioversion is the delivery of energy that is synchronized to the large R waves or QRS complex.

  5. Indications • Supraventricular tachycardia • Atrial fibrillation • Atrial flutter • Ventricular tachycardia

  6. Pulseless ventricular tachycardia (VT) • Ventricular fibrillation (VF) • Cardiac arrest due to or resulting in VF

  7. Contraindications • digitalis toxicity and catecholamine-induced arrhythmia • Multifocal atrial tachycardia

  8. Anesthesia • Cardioversion is almost always performed under induction or sedation (short-acting agent such as midazolam)

  9. Equipment • Defibrillators • Paddle • adhesive patch • Conductive gel or paste • ECG monitor with recorder • Oxygen equipment • Intubation kit Emergency • pacing equipment

  10. Positioning • Ant&post • Ant&lat • Ant&Rt Inf scapular • Ant&lt Inf scapular

  11. Monophasic vs biphasic waveforms • Monophasic defibrillation delivers a charge in only one direction, • biphasic defibrillation delivers a charge in one direction for half of the shock and in the electrically opposite direction for the second half. • Biphasic waveforms defibrillate more effectively and at lower energies than monophasic waveforms

  12. Synchronized electrical cardioversion begins with 25-50 treat atrial flutter • 50-100 treat atrial fibrillation

  13. Rapid polymorphic ventricular tachycardia (rate >150 bpm) associated with hemodynamic instability should be treated with immediate biphasic equivalent [100-200 J])

  14. Monomorphic ventricular tachycardia should be treated with biphasic equivalent [50-100 J]. • Ventricular fibrillation should be treated with unsynchronized electrical counter shock with biphasic equivalent [100-200 J].

  15. Complications • Atrial fibrillation • Ventricular fibrillation • Junctional premature beats • ventricular fibrillation

  16. Thromboembolization is associated with cardioversion in 1-3% of patients • Myocardial necrosis can result from high-energy shocks • Pulmonary edema is a rare complication of cardioversion • Painful skin burns can occur after cardioversion or defibrillation

  17. دستگاه بایفازیک با انرژی کمتر موفقیت بیشتر ویا مساوی از دستگاه مونو فازیک دارد

  18. میزان شوک در اطفال • 2j/kg • 4j/kg • 4j/kg

  19. پدل نباید بر روی پچ ترانس درمال قرار گیرد

  20. شوک بر روی یخ وبرف مانعی ندارد • بیمار در آب وبیمار با تعریق فراوان نباید شوک داد.

  21. اندازه پدل در بزرگسالان 8*12 است. • هر چه پدل کوچکتر باشد شانس نکروز میوکارد بالا می رود.

  22. فاصله بین پدل و ICD باید حداقل 8 سانتی متر باید باشد.

  23. THE ENDthank you

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