WEEK3-Defibrillation Flashcards
what are the 5 P’s/ what to do if it occurs
pendants/piercings- remove these where possible or consider alternative pad positioning
pacemaker- if an implantable device is present, place pads more than 8cm away from the device or consider alternative ad positioning
perspiration- sweat will prevent pads/ ECG electrodes from sticking
playtex- remove the clothes/bras. cut to remove quickly
patches- medication patches can be removed
how to apply the defib pads (1st position to try)
PAD 1 (anterior)
2nd intercostal space
mid-clavicular (right-hand side collar bone)
PAD 2 (lateral)
mid- axillary line (under the armpit)
5th intercostal space (level with v6 ECG electrode positioning)
how to apply the defib pads (2nd position to try)
PAD 1 (anterior)
patients left hand side
centre of the clavical
5th intercostal space (over the apex)
PAD 2 (posterior)
patients left hand side
back below the scapular
opposite the pad on front of the chest
what is defibrillation
a shock that is strong enough to stun a large majority of the cardiac tissue
REMEMBER: not all cardiac arrest patients need a shock because some heart rhythms won’t respond to a shock
how do you know if the heart rhythm is normal
rate =normal (between 60-100 bpm)
rhythm=regular (pqrst all there and uniform)
p wave= present
qrs= present, narrow, stays the same throughout
t wave= present
PULSE IS PRESENT
what are the normal heart rate values
60-100 beats per minute= normal
more than 100 beats per minute= tachycardia
less than 60 beats per minute= bradycardia
less than 40 beats per minute= absolute bradycardia
what does NSR mean
normal sinus rhythm
what are the shockable rhythms
ventricular fibrillation (VF)
Pulseless ventricular tachycardia (VT)
How do you recognise VT
3 consecutive qrs compleces at a rate greater than 100bpm.
has similar qrs structure each beat but will be wide
qrs is usually smooth and tall
rate= fast (usually 100-200 bpm)
rhythm= regular
p waves= absent (cant be detected)
qrs= present,wide and stays the same throughout
t wave= absent
pulse= vt as a whole can have a pulse and can’t have a pulse (PULSE VT OR PULSELESS VT)
which VT can you shock
pulseless vt= can shock
pulse vt= cant shock
when you detect vt ensure to check pulse before shocking/not shocking
How do you recognise vf
wide ventricular tachyarrhythmia (fast abdominal rhythm) with a chaotic morphology (structure.)
shape, width and height will keep changing
rate= fast (too rapid to count)
rhythm= irregular
p wave= absent
qrs= present, wide, irregular, changes in morphology (width, height, structure) throughout
t wave= absent
pulse= no
what are the non-shockable rhythms
pulseless electrical activity (PEA)
asystole
and a vt with a pulse
How do you recognise pea
electromechanical dissociation- some electrical activity but not sufficient enough.
meaning heart isn’t pumping adequately enough to generate a palpable pulse
pea can be present in many different ways (long difference- like bradycardia) (can look like a nsr but with no pulse)
rate= normally slow but can also be normal or faster
rhythm= normally organised and some pqrst structures can be seen
p waves= may be present
qrs= may be present
t waves= may be present
pulse= no, this is what helps define pea!
how to recognise asystole
easiest to find!
complete lack of electrical activity in the heart
= pulselessness
has no components of pqrst structure
asystole occurs when there’s a problem with electrical system of the heart and no electrical impulses can be generated
rate= 0
rhythm= nothing present
p waves= absent
qrs= absent
t waves= absent
pulse= no pulse
how to conduct defib safely
take off oxygen mask/place 1 away from patient’s chest. ventilator circuit should remain attached. this will minimise a fire occurring
correct pad placement is key
don’t shock when someone is touching the patient. head, middle, bottom clear otherwise can cause risk to person touching patient.
shock can be safely delivered without interrupting chest compressions for more than 4 seconds (less than 5)
