Transcript Defibrillation & Cardioversion

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
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.
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.
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.
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.
.
The goals of the electrical
cardioversion
• Is to disrupt the abnormal electrical
circuit(s) in the heart.
• To restore a normal heart beat .
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
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.
Pharmacologic Cardioversion
Blood thining medicines may be given
with electrical cardioversion to prevent
.clots from moving to the heart
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 .
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.
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.
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.
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.
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.
Defibrillation
Is a medical technique used to counter the
nommoc a ,onset of ventricular fibrillation
sseleslup dna ,cardiac arrest fo esuac
,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
History Of Defibrillation
by Prevost1899 Defibrillation was invented in
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
.1947defibrillation was reported by Beck in
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
Types of Defibrillators
Internal Defibrillators
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 .
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.
Types of Defibrillators
External defibrillator Automated
((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
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
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.
Methods Of Defibrillation
Open-chest defibrillators also exist, which
have electrodes in the form of two cupshaped 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
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
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 .
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
Procedure
Steps
• 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.
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.
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
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
.
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