LO2 and 4 Manual Defibrillation and advanced cardiac procedures

Question 1

Defibrillation

Answer 1

• Surge of electric energy delivered to the heart
• Delivers a current to the heart powerful enough to depolarize
• Needs to be carried out as soon as possible in VF or pulseless VT
• Not useful in asystole

Question 2

Monophasic

Answer 2

delivers shock to the heart from one vector

Question 3

Biphasic

Answer 3

delivers a shock from two vectors, therefore allowing for lower joule settings.

Question 4

Sequence for Manual Defibrillation

Answer 4

• One paramedic should ready the monitor-defibrillator while the other carries out the following steps (C-A-B):

Assess for cardiac arrest

Start chest compressions.

Assess rhythm and need
for defibrillation.

Ensure a clear airway,
suction if required, and provide ventilation.

Sequence for Manual Defibrillation

Question 5

Treatment for VF or pulseless VT

Answer 5

• Follow the “C-A-B” approach to CPR.
• Interpret the rhythm with a simultaneous
• pulse check for a maximum of 10 seconds Confirm VF or Pulseless VT on the monitor-defibrillator.
• Verify patient is unresponsive, has no palpable pulse, and you have good lead connections.
• If shockable rhythm, clear the patient and then defibrillate.
• Attach the adhesive defibrillation pads to the chest as instructed on the package.
• Turn the power switch on.
• Charge the defibrillator to appropriate joule setting.
• Remove nitroglycerin patch if present.
• Clear the area and press the Shock button.
• Resume CPR immediately.
• An implanted artificial pacemaker is not a contraindication to defibrillation.

Question 6

Transcutaneous Pacing (TCP)

Answer 6

• Also called external cardiac pacing
• Included in the treatment algorithms for symptomatic bradycardia for ACP
  • Electrode attachment for external pacing:
  • preferred anterior-posterior placement

Question 7

Synchronized Cardioversion

Answer 7

• Used for SVT
  o Adenosine is used first but if it doesn’t work then synchronized cardioversion
• Used to terminate tachy dysrhythmias other than VF and pulseless VT
• Designed to deliver the shock about 10 milliseconds after the peak of the QRS complex, avoiding the “vulnerable” relative refractory period
  May reduce the energy required to end the dysrhythmia
• May decrease the potential for development of secondary complicating dysrhythmias

Question 8

Extracorporeal life support

Answer 8

• Cannulating large blood vessels and diverting blood to a machine that oxygenates the blood before returning it to the body
• Allows physcians extra time to reverse the life threatening effects of reversible causes

Question 9

Intra-aortic pump

Answer 9

• Helium filled balloons placed in the proximal descending aorta
• These balloons are synchronized to an ECG waveform of a beating heart to inflate during diastole and deflate during systole

Question 10

Impella heart pump

Answer 10

• Percutaneous LVAD

- It has an inlet and outlet and is capable of pumping 5 L of blood in a minute through the left ventricle

Question 11

LVAD

Answer 11

• are implemented mechanical devices that support circulation in patients with severe left-sided heart failure
• Do not generate a pulse but rather a continuous pressure equivalent to the map
• Often respond well to small fluid boluses if have hypertension