chapter 9: defibrillation

Question 1

where do you position the pads

Answer 1

right, below clavicle
left, v6, mid axillary line ( below breast)

Question 2

what are the other pad positions

Answer 2

antero-posterior ( below left clavicle, left scapula)
postero lateral ( v6 mid axillary line, right scapula)
bi-axillary ( left and right lateral chest wall)

Question 3

management for unwitnessed cardiac arrest

Answer 3

CPR whilst waiting for defib
Attempt defib ASAP

Question 4

management for witnessed and monitored cardiac arrest

Answer 4

VF/pVT, give 3 successive shocks
check for ROSC + rhythm change after each attempt
CPR for 2 mins if 3rd shock unsuccessful

Question 5

steps for manual defib

Answer 5

1- shake patient, if no response open airways, check pulse
2- call 2222, adult cardiac arrest team
3- CPR, Apply defib pads
4- plan what rest of team does, briefly pause CPR check rhythm
5- confirm VF/pVT
6- Resume CPR immediately, warn everyone else to stand clear, remove any oxygen device
7- select energy setting, charge defib
8- tell CPR person to stand clear then give the shock
9- immediately restart CPR, continue for 2 mins
10- check monitor, if VF/pVT, repeat until 3 shocks have been given

Question 6

what to do after 3 shocks

Answer 6

1- 1mg adrenaline IV, 300mg amiodarone IV, continue CPR for 2 mins, check for ROSC (withhold adrenaline if there is)
2- 1mg adrenaline IV after alternate shocks
3- if ROSC, post resus care. No ROSC, continue to non shockable algorithm