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Defibrillator

The document provides an overview of defibrillators, including their function, types, and components. It explains the differences between monophasic and biphasic waveforms, emphasizing the importance of delivering optimal current to the heart while minimizing the risk of injury. Additionally, it highlights potential problems and safety features associated with defibrillator use.

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4 views

Defibrillator

The document provides an overview of defibrillators, including their function, types, and components. It explains the differences between monophasic and biphasic waveforms, emphasizing the importance of delivering optimal current to the heart while minimizing the risk of injury. Additionally, it highlights potential problems and safety features associated with defibrillator use.

Uploaded by

Kâmēl Mâlēk
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Amjad Adnan

Anaesthesia department

2017
Defibrillator

This is a device that delivers electrical energy to the heart causing simultaneous
depolarization of an adequate number of myocardial cells to allow a stable rhythm to
be established.

 The shock can be delivered by means electrodes placed on the chest of the
patient (external defibrillation) or the electrodes may be held directly against
the heart when the chest is open (internal defibrillation).
 Higher voltage are required for external defibrillation than internal
defibrillation

An energy storage capacitor is charged at a relatively slow rate from:


 The AC line by means of a step-up transformer and rectifier arrangement or.
 A battery and DC to DC converter arrangement

 Energy level of defibrillators is from 2 to 400 Joules (J)(depends on the size of the
patient and skin resistance).
 Required voltage in the range of 1000 to 6000 V (depend on the duration of the
DC pulse).
 Current range 1 to 20 A

Defibrillators can be divided into:


 Automated external defibrillators (AEDs)
 Manual defibrillators
Components
1. The device has an on/off switch, Joules setting control, charge and discharge
buttons.
2. 2. Paddles can be either external (applied to the chest wall) or internal (applied
directly to the heart). The external paddles/pads are usually 8–8.5 cm in size.

 Defibrillation is often an important step in cardiopulmonary


resuscitation (CPR).
 Defibrillation is indicated only in certain types of cardiac dysrhythmias,
specifically ventricular fibrillation (VF) and pulseless ventricular tachycardia.
 If the heart has completely stopped, as in asystole or pulseless electrical
activity (PEA), defibrillation is not indicated.

The external paddles/pads are positioned on the sternum and on the left maxillary
line (fifth–sixth rib).
1-Monophasic Waveforms: A type of defibrillation waveform where a shock is
delivered to the heart from one vector as shown below. It is shown graphically as
current vs. time.

 In this waveform, there is no ability to adjust for patient impedance, and it is


generally recommended that all monophasic defibrillators deliver 360J of
energy in adult patients to insure maximum current is delivered in the face of
an inability to detect patient impedance.
 Deliver current that is unipolar (i.e. one direction of current flow) they are not
used in modern practice as they were likely to have waveform modification
depending on transthoracic impedance (e.g. larger patients with high
transthoracic impedance received considerably less transmyocardial current
than smaller patients).

2-Biphasic Waveforms: A type of defibrillation waveform where a shock is


delivered to the heart via two vectors. Biphasic waveforms were initially
developed for use in implantable defibrillators and have since become the
standard in external defibrillators.
 Deliver a two-phased current flow in which electrical current flows in
one direction for a specified duration, then electronically adjusting
the waveform magnitude and duration to ensure optimal current
delivery to the myocardium, irrespective of the patient’s size.
3-Monophasic vs biphasic performance: the highest part of the current
waveform is known as the ‘peak current’ when the most current is flowing. Note the
difference in height (amps) between the monophasic peak current and the biphasic
peak current. Too much peak current during the shock can injure the heart. It’s the
peak current, not energy that can injure the heart. The goal of defibrillation is to
deliver enough current to the heart to stop the lethal rhythm but with a low peak
current to decrease risk of injury to the heart muscle.

Problems in practice and safety features


1. Skin burns.
2. Further arrhythmias

In Summary ………….

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