Defibrillator

Sameen Hanif
Learning Outcome

 DEFINE
 TYPES
 USES
Defibrillator

A defibrillator is a medical device used to deliver an

electrical shock to the heart in order to restore normal heart
rhythm in cases of life-threatening cardiac arrhythmias,
particularly ventricular fibrillation (VF) and pulseless
ventricular tachycardia (VT).
These arrhythmias can lead to sudden cardiac arrest, where
the heart ceases to pump effectively, and the individual
becomes unresponsive and stops breathing
Types

There are two types of defibrillator:

1. External Defibrillators
2. Implantable Cardioverter Defibrillators (ICDs)
External Defibrillators

These are portable devices commonly found in public places,

hospitals, and ambulances.
They are used by trained individuals, such as paramedics or
healthcare providers, to administer a shock to a person in
cardiac arrest.
External defibrillators can be semi-automatic or fully automatic.
Semi-automatic defibrillators require the operator to analyze
the rhythm and decide when to deliver a shock, while fully
automatic defibrillators analyze the rhythm and deliver a shock
automatically if needed.
Implantable Cardioverter Defibrillators
(ICDs):
These are surgically implanted devices designed to
continuously monitor the heart's rhythm.
If they detect a dangerous arrhythmia, they can deliver an
electrical shock to restore normal heart rhythm.
ICDs are typically recommended for individuals at high risk
of sudden cardiac arrest due to certain heart conditions,
such as ventricular arrhythmias or a history of cardiac arrest.
ROLE OF DIFIBRILLATOR
 The role of a defibrillator is to deliver an electrical shock to the heart
in order to restore a normal heart rhythm in cases of life-threatening
cardiac arrhythmias, particularly ventricular fibrillation (VF) and
pulseless ventricular tachycardia (VT). Defibrillators play a crucial
role in the management of sudden cardiac arrest, a condition where
the heart suddenly stops pumping effectively, leading to loss of
consciousness and cessation of breathing.
 Here are some key aspects of the role of a defibrillator:
1. Restoration of Normal Heart Rhythm
2. Emergency Intervention
3. Automated Analysis
4. Integration with CPR
5. Monitoring and Support
Restoration of Normal Heart Rhythm

The primary purpose of a defibrillator is to restore a normal

heart rhythm by delivering a controlled electrical shock to
the heart.
This helps terminate chaotic arrhythmias like ventricular
fibrillation or pulseless ventricular tachycardia, allowing the
heart's natural pacemaker to resume normal function.
Emergency Intervention

Defibrillators are used in emergency situations, such as

sudden cardiac arrest, where immediate intervention is
required to save a person's life.
They are commonly found in public places, healthcare
facilities, and ambulances to enable rapid access and
deployment in critical situations.
Automated Analysis

Many modern defibrillators are equipped with automated

features that analyze the heart rhythm and determine
whether a shock is necessary.
This simplifies the process for trained responders and
ensures prompt delivery of therapy when needed.
Integration with CPR

Defibrillation is often integrated into the broader context of

cardiopulmonary resuscitation (CPR).
High-quality CPR, including chest compressions and rescue
breaths, helps circulate oxygenated blood to vital organs
while the defibrillator is prepared and deployed.
Monitoring and Support

Some defibrillators, particularly implantable cardioverter

defibrillators (ICDs), provide continuous monitoring of the
heart rhythm and can deliver therapy as needed to prevent
sudden cardiac arrest in individuals at high risk due to
certain heart conditions.
Defibrillator

 Ventricular fibrillation develops most commonly in adults

who experience non traumatic cardiac arrest.
 The time from collapse to defibrillation is the most
important determinant of survival.
 The chances for survival decline 7–10% for every minute
without defibrillation.
 Therefore, patients who have cardiac arrest should be
defibrillated at the earliest possible moment.
 Health care personnel working in hospitals and ambulatory
care facilities must be able to provide early defibrillation
to collapsed patients with ventricular fibrillation as soon
as possible.
 Shock should be delivered within 3 min (±1 min) of arrest.
Automated external defibrillators
(AEDs)
 In many institutions, automated external defibrillators
(AEDs) are increasingly being used throughout the
community by police, firefighters, security personnel,
sports marshals, ski patrol members, and airline flight
attendants, among others.
 They are placed in any public location where 20,000 or
more people pass by every day.
 AEDs are technologically advanced, microprocessor-based
devices that are capable of electrocardiographic analysis
with very high specificity and sensitivity in differentiating
shockable from nonshockable rhythms.
Energy

 There is no definite relationship between the energy

requirement for successful defibrillation and body size.
 A shock with too low an energy (current) level will not
successfully defibrillate; conversely, too high an energy
level may result in functional and morphological injury.
 Defibrillators deliver energy in either monophasic or
biphasic waveforms.
 Increasingly, biphasic waveforms are recommended for
cardioversion as they achieve the same degree of success
but with less energy and theoretically less myocardial
damage.
 All AEDs manufactured today deliver some type of biphasic
waveform shock.
 Compared with monophasic shocks, biphasic shocks deliver
energy in two directions with equivalent efficacy at lower
energy levels and possibly with less myocardial injury.
 These devices deliver impedance compensating shocks
employing either biphasic truncated exponential (BTE) or
rectilinear (RBW) morphology.
 Biphasic shocks delivering low energy for defibrillation
(120–200 joule [J]) have been found to be as or more
effective than 200–360 J monophasic damped sine (MDS)
waveform shocks.
Placement of electrode

 When using AEDs, one electrode pad is placed beside the

upper right sternal border, just below the clavicle, and the
other pad is placed just lateral to the left nipple, with
the top of the pad a few inches below the axilla.
 A decrease in time delay between the last compression
and the delivery of a shock (the preshock pause) has
received special emphasis in the new guidelines.
 Stacking shocks increases the time to next compression,
and it has been noted that the first shock is usually
associated with a 90% efficacy.
 Thus, stacked shocks have been replaced by a recommen-
dation for a single shock, followed by immediate
resumption of chest compressions.
Atrial fibrillation

 For cardioversion of atrial fibrillation, 120–200 J can be

used initially with escalation if needed.
 For atrial flutter or paroxysmal supraventricular
tachycardia (PSVT), an initial energy level of 50–100 J is
often adequate.
 All mono-phasic shocks should start with 200 J.
Ventricular tachycardia

 Ventricular tachycardia, particularly monomorphic

ventricular tachycardia, responds well to shocks at initial
energy levels of 100 J.
 For polymorphic ventricular tachycardia or for ventricular
fibrillation, initial energy can be set at 120–200 J.
 Cardioversion should be synchronized with the QRS
complex and is recommended for hemodynamically stable,
wide-complex tachycardia requiring cardioversion, PSVT,
atrial fibrillation, and atrial flutter.
 Polymorphic VT should be treated as VF with
unsynchronized shocks.
VENTICULAR FLUTTER
Atrial fibrillation (AF)

 Atrial fibrillation (AF) is a common type of cardiac

arrhythmia characterized by irregular and often rapid
heartbeats originating in the upper chambers of the heart,
known as the atria. Instead of the normal coordinated
contraction, the atria fibrillate or quiver, leading to an
irregular heartbeat.
Types
1. Paroxysmal AF: Episodes come and go and usually stop on
their own within 48 hours.
2. Persistent AF: Episodes last longer than 7 days and may
require medical intervention to restore normal heart
rhythm.
3. Long-standing persistent AF: Continuous AF lasting longer
than 12 months.
4. Permanent AF: The irregular rhythm is present all the
time, and attempts to restore normal sinus rhythm have
failed or are not pursued.
ECG VARIATIONS

1. Absence of P waves
2. Irregularly irregular rhythm
3. Narrow QRS complexes
4. Fast ventricular rate
5. R-R interval variability
VENTRICULAR FIBRILLATION

 Ventricular fibrillation (VF) is a life-threatening cardiac

arrhythmia characterized by rapid, disorganized, and
chaotic electrical activity in the ventricles of the heart.
Instead of the coordinated contraction required for
effective pumping of blood, the ventricles quiver
ineffectively, leading to a loss of cardiac output and
sudden cardiac arrest if not promptly treated.
ECG VARIATIONS

1. Instead of the usual P waves, QRS complexes, and T

waves seen in a normal ECG, the tracing will show rapid,
irregular, and chaotic deflections.
2. No Coordinated QRS Complexes or T Waves
3. Flat or Absent Waves
ASSIGNMENT?

 MONOMORPIC
 BIPHASIC