Pt 7 Defibrillation & Synchronized Shock Flashcards
* Defibrillation & synchronized shock
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Is the treatment of choice for VFib & pulseless VTach
> Most effective when completed within 2 min of dysrhythmia onset
Defibrillation
- Passage of DC electrical shock through the heart to depolarize cells of myocardium
- Allows SA node to resume PM role
- Monophasic defibrillators deliver energy in 1 direction
- Biphasic defibrillators deliver energy in 2 directions
> Use lower energies
> Fewer post-shock ECG abnormalities
- Output is measured in joules or watts per second
- Recommended energy for initial shocks in defibrillation
> Biphasic: __-__ joules
> Monophasic: __ joules - Immediate CPR w/chest compressions >first shock
120-200
360
LifePak contains a monitor, defibrillator, & transcutaneous pacemaker
An AED is a defibrillator that has rhythm detection capability & the ability to advise the operator to deliver a shock using hands-free defibrillator pads
- Proficiency in the use of the AED is a part of the BLS course for HCP’s
- Start CPR while obtaining & setting up defibrillator
- Turn on & select energy
- Make sure sync button is turned off
- Apply gel pads
- Charge
- Position paddles firmly on chest
- Ensure “All clear!”
- Deliver charge
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Includes anti-tachycardia & anti-bradycardia PM’s
> Overdrive pacing for tachycardias
> Backup pacing for bradycardias
- Pre & post-procedure care same as PM
Implantable cardioverter defibrillator (ICD)
ICD
- Variety of emotions are possible
> Fear of body image change
> Fear of recurrent dysrhythmias
> Expectation of pain with ICD discharge
> Anxiety about going home
- Participation in an ICD support group should be encouraged
Patient & Caregiver Teaching
- Follow-up appts (w/cardiologist)
- Incision care (dry incision for 4 days or as instructed)
- Arm restrictions
- Sexual activity (resume once incision healed)
- Driving (avoid until cleared)
- Avoid direct blows
- Avoid large magnets, MRI
Patient & Caregiver Teaching cont’d
- Air travel (is not restricted; notify of presence as may set off metal detector; hand-held wand shouldn’t be placed directly over)
- Avoid antitheft devices (in doorways of stores & buildings)
- What to do if ICD fires
> Call cardiologist immediately; if ICD fires & you feel sick, contact EMS; if fires more than once, contact EMS
- Medic Alert ID
- ICD identification card (& list of current rx’s)
- Caregivers to learn CPR
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Is the therapy of choice for the pt w/ventricular (VT w/a pulse) or supraventricular tachy-dysrhythmias (afib w/a rapid ventricular response)
Synchronized cardioversion
- A synchronized circuit in the defibrillator delivers a countershock that is programmed to occur on the R wave of the QRS complex of the ECG
- Procedure similar to defibrillation except sync button turned ON
- If pt stable, sedate prior [Versed]
> For pts that’re awake & hemodynamically stable; done on a non-emergent basis
! Watch the airway
- Initial energy lower
> 70-75 joules (biphasic)
> 100 joules (monophasic) - If pt becomes pulseless or rhythm changes to VF, turn sync button off & defibrillate
? Cardioversion
- HIGH energy shock
- Regular defibrillation
- Used for pulseless (VT/VF) or unstable pt
Unsynchronized
? Cardioversion
- LOW energy timed to deliver @ the peak of the QRS
- Delays the shock for the right moment
- Avoids delivery of shock during repolarization (T wave) which can cause V FIB
> Indications for = unstable afib, atrial flutter, atrial tachycardia, SVT’s
Synchronized
For cases where electrical shock is needed, if the pt is stable and you can see a QRS-T complex, use __ energy synchronized cardioversion
If pt is pulseless or unstable & defibrillator will not synchronize, use __ energy unsynchronized cardioversion (defibrillation)
LOW
HIGH
