Learning Objectives:

After 20 minutes lecture/ discussion, the students will be able to:

1. Answer what is defibrillation all about.
2. Discuss its purpose, safety precautions, and how to prepare defibrillator.
3. Know the two types of Defibrillator and discuss its meaning and difference.
4. Put in mind the proper placement of defibrillator internally and externally .
5. Identify the risks / complication of defibrillation and it's normal results.
6. Develop functionality through after care .
7. Inculcate the nursing considerations upon doing the procedures.
8. Instill at least 90% of the discussion in one's heart.
9. Evaluate through quiz or group activities.

Defibrillation is the definitive treatment for the life-threatening cardiac arrhythmias,

ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a
therapeutic dose of electrical energy to the affected heart with a device called a defibrillator. This
depolarizes a critical mass of the heart muscle, terminates the arrhythmia, and allows normal sinus
rhythm to be reestablished by the body's natural pacemaker, in the sinoatrial node of the heart.
Defibrillators can be external, transvenous, or implanted, depending on the type of device used or
needed. Some external units, known as automated external defibrillators (AEDs), automate the
diagnosis of treatable rhythms, meaning that lay responders or bystanders are able to use them
successfully with little, or in some cases no training at all.

PURPOSE:

Defibrillation is performed to correct life-threatening arrhythmias of the heart including

ventricular fibrillation and cardiac arrest. In cardiac emergencies it should be performed immediately
after identifying that the patient is experiencing an arrhythmia, indicated by lack of pulse and
unresponsiveness. If an electrocardiogram is available, the arrhythmia can be displayed visually for
additional confirmation. For medical treatment by a physician, in non-life threatening situations, atrial
defibrillation can be used to treat atrial fibrillation or flutter.

PRECAUTIONS

Defibrillation should not be performed on a patient who has a pulse or is alert, as this could
cause a lethal heart rhythm disturbance or cardiac arrest. The paddles used in the procedure should
not be placed on a woman's breasts or over an internal pacemaker.

PREPARATION

Once a patient is found in cardiac distress, without a pulse and non-responsive, and help is
summoned, cardiopulmonary resuscitation (CPR) is begun and continued until the caregivers arrive
and are able to provide defibrillation. Electrocardiogram leads are attached to the patient chest. Gel or
paste is applied to the defibrillator paddles, or two gel pads are placed on the patient's chest. The
caregivers verify lack of a pulse while visualizing the electrocardiogram, assure contact with the
patient is discontinued, and deliver the electrical charge.
Atrial defibrillation is a treatment option that will be ordered for treatment of atrial fibrillation or
flutter. The electrocardiogram will be monitored throughout the procedure. The paddles are placed on
the patients chest with conducting gel to ensure good contact between the paddles and skin. If the
heart can be visualized directly during thoracic surgery, the paddles will be applied directly to the
heart. The defibrillator is programmed to recognize distinct components of the electrocardiogram and
will only fire the electrical shock at the correct time. Again, all direct contact with the patient is
discontinued prior to defibrillation.

Two Types of Defibrillator

1. External Defibrillator

The units are used in conjunction with (or more often have inbuilt) electrocardiogram readers,
which the healthcare provider uses to diagnose a cardiac condition (most often fibrillation or
tachycardia although there are some other rhythms which can be treated by different shocks). The
healthcare provider will then decide what charge (in joules) to use, based on proven guidelines and
experience, and will deliver the shock through paddles or pads on the patient's chest. As they require
detailed medical knowledge, these units are generally only found in hospitals and on some
ambulances. For instance, every NHS ambulance in the United Kingdom is equipped with a manual
defibrillator for use by the attending paramedics and technicians. In the United States, many
advanced EMTs and all paramedics are trained to recognize lethal arrhythmias and deliver
appropriate electrical therapy with a manual defibrillator when appropriate.

2. Internal Defibrillator
These are the direct descendants of the work of Beck and Lown. They are virtually identical to
the external version, except that the charge is delivered through internal paddles in direct contact with
the heart. These are almost exclusively found in operating theatres, where the chest is likely to be
open, or can be opened quickly by a surgeon.

PLACEMENT

Anterio-apical placement of external defibrillator electrodes (When defibrillation is

unsuccessful, anterior-posterior placement is also sometimes attempted)
Resuscitation electrodes are placed according to one of two schemes. The anterior-posterior
scheme (conf. image) is the preferred scheme for long-term electrode placement. One electrode is
placed over the left precordium (the lower part of the chest, in front of the heart). The other electrode
is placed on the back, behind the heart in the region between the scapula. This placement is preferred
because it is best for non-invasive pacing.
The anterior-apex scheme can be used when the anterior-posterior scheme is inconvenient or
unnecessary. In this scheme, the anterior electrode is placed on the right, below the clavicle. The apex
electrode is applied to the left side of the patient, just below and to the left of the pectoral muscle. This
scheme works well for defibrillation and cardioversion, as well as for monitoring an ECG.

RISKS/COMPICATIONS

1. Dysrhythmias Pulmonary edema

2. Cardiac arrest Pulmonary or systemic emboli
3. Respiratory arrest Equipment malfunction
4. Neurologic impairment Death
 5. Altered skin integrity
6. Skin burns
7. Injury to the heart muscle, abnormal heart rhythms, blood clots

NORMAL RESULTS
Defibrillation performed to treat life-threatening ventricular arrhythmias is most likely to be
effective within the first five minutes, preventing brain injury and death by returning the heart to a
productive rhythm able to produce a pulse. Patients will be transferred to a hospital critical care unit for
additional monitoring, diagnosis, and treatment of the arrhythmia. Intubation may be required for
respiratory distress. Medications to improve cardiac function and prevent additional arrhythmias, are
frequently administered. Some cardiac function may be lost due to the actual defibrillation, but is also
associated with the underlying disease.
Atrial defibrillation is successful at restoring cardiac output, alleviating shortness of breath, and
decreasing the occurrence of clot formation in the atria.

AFTER CARE
After defibrillation, the patient's cardiac status, breathing, and vital signs are monitored with a
cardiac monitor . Additional tests to measure cardiac damage will be performed, which can include a
12 lead electrocardiogram, a chest x-ray, and cardiac catheterization . Treatment options will be
determined from the outcome of these procedures. The patient's skin is cleansed to remove gel and, if
necessary, electrical burns are treated.

NURSING CONSIDERATIONS

1. Establishes a visual recording and a permanent record of current ECG

status and response to intervention.
2. Maintains safety to caregivers, since electric current can be conducted from
the patient to another individual if contact occurs.
3. ECG rhythm may change, ensure it is a rhythm that requires defibrillation.
4. Necessary to maintain the delivery of oxygenated blood to vital organs.
5. Provides for completion of medical/ nursing records.

Sources:
http://www.surgeryencyclopedia.com/Ce-Fi/Defibrillation.html

"Defibrillation." American Heart Association. [cited May 2003]. http://www.americanheart.org