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Emergency Resuscitation Equipment Deanship of Graduate Studies & Scientific Research, 21 September University of Medical & Applied Sciences. Presented by: Mosa Alfageh BS, MsRC Student Supervised by: DR: Ahmed Akroot Fad Dahmesh BS, MsRC Student
Outline DC shock Crash card
Direct current (Much stronger& safer than alternating electric current) What DC Shock stand for? C=cardioversion Shock D=Defibrillation Shock D.C shock
Types of Shock Defibrillation Cardioversion Defibrillation is a non-synchronized delivery of energy during any phase of the cardiac cycle. Cardioversion is the delivery of energy that is synchronized to the large R waves or QRS complex. D.C shock
D.C shock Types of defibrillators:- Manual external defibrillator Manual internal defibrillator automated external defibrillator (AED) implantable cardioverter defibrillator (ICD) wearable cardioverter defibrillator
Manual external defibrillator Shock will be delivered through paddles applied to the patients chest found in hospitals and ambulances D.C shock Manual internal defibrillator Same as manual external except pads are in direct contact with the heart usually found in operating rooms Automated external defibrillator use computer to analyze heart then suggest whether a Shock is needed or not usually found in public places made simpler for anyone to use
Implantable cardioverter defibrillator an electronic device that constantly monitors heart rate and rhythm When it detects a very fast ,abnormal rhythm it delivers energy to the heart muscle .This causes the heart to beat in a normal rhythm again . used for cardioversion ,defibrillation , anti -tachycardia pacing &bradycardia pacing . Wearable cardiac defibrillator portable defibrillator that is worn as a vest , monitors heart 24h/7d not as common as others D.C shock
Cardioversion Pharmacological electrical external internal A- external DC Shock using paddles B- ICD Shock
DEFIBRILLATOR ELECTRODES Types of Defibrillator electrodes:- a) Spoon shaped electrode Applied directly to the heart. b) Paddle type electrode Applied against the chest wall. c) Pad type electrode Applied directly on chest wall.
Waveforms 1-Monophasic Waveform Delivers current in One direction between the two Electrode D.C shock 2-Biphasic waveform Delivers current in tow directions (positive and negative) needs higher energy levels Higher efficacy in restoring SR in case of arrest
D.C shock
How much joules will you give? It depends on certain factors Types of wave form (monophasic or biphasic) Type of arrhythmia Age of the patient (adult or child) D.C shock
D.C shock Is this the same in a child? 2-4Joules/Kg The power of the DC Shock is adjusted according to the body weight Is this the same power used in ICD Shock? 36-40J Transvenous ICD The power of ICD Shock needed to terminate VT/VF are less than external DC Shock
D.C shock How can we give DC shocks ? Anteroposterior position Anterolateral position (anteroapical ) Right parasternal Left paravertebral
How can we give DC Shock ? Anterolateral position :- less successful in restoring sinus rhythm suitable in case of elective cardioversion and cardiac arrest Anteroposterior position :- more successful in restoring sinus rhythm (higher delivery of electric current ) suitable in case of elective cardioversion but unsuitable in case of cardiac arrest .
Steps of giving cardioversion :- 1- obtain an informed consent (unless emergent or life saving ) 2- in elective case ,fasting for 6-8 h 3- perform 12 lead ECG to document termination of tachyarrhythmia & restoration of SR after cardioversion . 4- Ensure an IV access 5- the crash car with all the resuscitation equipment should be beside the patient 6- You should have another doctor or a nurse accompanying you 7-attach at least 3 ECG electrodes to the patient
8- put the patient in lateral position 9- Check the ECG to make sure that the tachyarrhythmia didnt resolve spontaneously. At the time no need for DC Shock Steps of giving cardioversion :- 10- Give IV sedation :- IV medazolam (dormicum) IV fentanyl IV propofol (deprevan) 11- press the sync button 12- adjust the joules at the the decided value in joules 13- remove ambu bag, oxygen mask or cannula at the time of delivery.
14- put adequate amount of gel on the paddles 15- put the paddles or patches in the Anteroposterior position 16- press (charge ) button and after you reach the desirable value press (deliver ) after you check the that everyone is clear Paddles shouldnt be too close 17- perform 12 lead ECG to document termination of tachyarrhythmia & restoration of SR after cardioversion Steps of giving cardioversion :-
Cardioversion Pharmacological electrical external internal A- external DC Shock using paddles B- ICD Shock
At which part of the ECG should it be delivered ? Absolute Refractory period Synchronized DC Shock DC Shock delivered on the complex (to avoid R on T phenomenon)
At which part of the ECG should it be delivered ? Absolute Refractory period Synchronized DC Shock DC Shock delivered on the complex (to avoid R on T phenomenon)
At which part of the ECG should it be delivered ? Absolute Refractory period Synchronized DC Shock DC Shock delivered on the complex (to avoid R on T phenomenon)
At which part of the ECG should it be delivered ? Ventricular fibrillation
Steps for giving Defibrillation (shockable rhythm ) A. start cardiac compressions immediately till another team member prepare for DC shocks B. the crash car with all the resuscitation equipment should be available C. Dont press the synchronization button D. put adequate amount of gel on the paddles E. put the paddles in an Anterolateral position F. adjust the joules at the maximum values in joules G. remove the ambu bag H. press (charge ) button and after you reach the desirable value press ( Deliver ) after you check that everyone is clear .
What should I do immediately after giving DC shocks ? Defibrillation oresume the cardiac compressions immediately for two minutes before checking the rhythm othen check the rhythm after two minutes Cardioversion o check the rhythm on the monitor to detect whether the Shock was successful or not and whether he developed bradyasystole or VF that necessitate starting CPR
Contraindications of DC Shock Defibrillation patient signed DNAR Cardioversion 1. atrial thrombosis 2. sinus rhythm 3. bradyasystole 4. automatic tachyarrhythmia (e.g. MAT or JT ) 5. digoxin toxicity (unless hemodynamically unstable) 6. patient cant be safely sedated 7. unknown duration of AF or flutter ( non anticoagulated patient in absence of TEE with no hemodynamically instability )
Complications:- most common -harmless arrhythmia like atrial / ventricular premature beats Serious complications A) ventricular fibrillation B) thrombo-embolisation C ) myocardial necrosis D) myocardial stunning E ) pulmonary edema F) painful skin burns
Cardioversion Vs Defibrillation a process of converting arrhythmia back to sinus rhythm SR it can be electrical (urgent ) or pharmacological (elective) delivery of DC Shock is synchronized to the QRS complex to prevent R on T phenomenon and triggering VF it is performed for 1- SVT 2- AF 3- atrial flutter 4- VT with social pulse ( hemodynamically stable or unstable) a process of immediate termination of VF using DC Shock only electrical (emergent ) delivery of DC Shock is not synchronized to the QRS complex due to absence of organized electrical activity its performed for 1- VF 2- Pulseless VT
Crash Card
SEMI NAR.pdf
SEMI NAR.pdf
SEMI NAR.pdf
SEMI NAR.pdf
SEMI NAR.pdf
SEMI NAR.pdf
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SEMI NAR.pdf

  • 1. Emergency Resuscitation Equipment Deanship of Graduate Studies & Scientific Research, 21 September University of Medical & Applied Sciences. Presented by: Mosa Alfageh BS, MsRC Student Supervised by: DR: Ahmed Akroot Fad Dahmesh BS, MsRC Student
  • 2. Outline DC shock Crash card
  • 3. Direct current (Much stronger& safer than alternating electric current) What DC Shock stand for? C=cardioversion Shock D=Defibrillation Shock D.C shock
  • 4. Types of Shock Defibrillation Cardioversion Defibrillation is a non-synchronized delivery of energy during any phase of the cardiac cycle. Cardioversion is the delivery of energy that is synchronized to the large R waves or QRS complex. D.C shock
  • 5. D.C shock Types of defibrillators:- Manual external defibrillator Manual internal defibrillator automated external defibrillator (AED) implantable cardioverter defibrillator (ICD) wearable cardioverter defibrillator
  • 6. Manual external defibrillator Shock will be delivered through paddles applied to the patients chest found in hospitals and ambulances D.C shock Manual internal defibrillator Same as manual external except pads are in direct contact with the heart usually found in operating rooms Automated external defibrillator use computer to analyze heart then suggest whether a Shock is needed or not usually found in public places made simpler for anyone to use
  • 7. Implantable cardioverter defibrillator an electronic device that constantly monitors heart rate and rhythm When it detects a very fast ,abnormal rhythm it delivers energy to the heart muscle .This causes the heart to beat in a normal rhythm again . used for cardioversion ,defibrillation , anti -tachycardia pacing &bradycardia pacing . Wearable cardiac defibrillator portable defibrillator that is worn as a vest , monitors heart 24h/7d not as common as others D.C shock
  • 9. DEFIBRILLATOR ELECTRODES Types of Defibrillator electrodes:- a) Spoon shaped electrode Applied directly to the heart. b) Paddle type electrode Applied against the chest wall. c) Pad type electrode Applied directly on chest wall.
  • 10. Waveforms 1-Monophasic Waveform Delivers current in One direction between the two Electrode D.C shock 2-Biphasic waveform Delivers current in tow directions (positive and negative) needs higher energy levels Higher efficacy in restoring SR in case of arrest
  • 12. How much joules will you give? It depends on certain factors Types of wave form (monophasic or biphasic) Type of arrhythmia Age of the patient (adult or child) D.C shock
  • 13. D.C shock Is this the same in a child? 2-4Joules/Kg The power of the DC Shock is adjusted according to the body weight Is this the same power used in ICD Shock? 36-40J Transvenous ICD The power of ICD Shock needed to terminate VT/VF are less than external DC Shock
  • 14. D.C shock How can we give DC shocks ? Anteroposterior position Anterolateral position (anteroapical ) Right parasternal Left paravertebral
  • 15. How can we give DC Shock ? Anterolateral position :- less successful in restoring sinus rhythm suitable in case of elective cardioversion and cardiac arrest Anteroposterior position :- more successful in restoring sinus rhythm (higher delivery of electric current ) suitable in case of elective cardioversion but unsuitable in case of cardiac arrest .
  • 16. Steps of giving cardioversion :- 1- obtain an informed consent (unless emergent or life saving ) 2- in elective case ,fasting for 6-8 h 3- perform 12 lead ECG to document termination of tachyarrhythmia & restoration of SR after cardioversion . 4- Ensure an IV access 5- the crash car with all the resuscitation equipment should be beside the patient 6- You should have another doctor or a nurse accompanying you 7-attach at least 3 ECG electrodes to the patient
  • 17. 8- put the patient in lateral position 9- Check the ECG to make sure that the tachyarrhythmia didnt resolve spontaneously. At the time no need for DC Shock Steps of giving cardioversion :- 10- Give IV sedation :- IV medazolam (dormicum) IV fentanyl IV propofol (deprevan) 11- press the sync button 12- adjust the joules at the the decided value in joules 13- remove ambu bag, oxygen mask or cannula at the time of delivery.
  • 18. 14- put adequate amount of gel on the paddles 15- put the paddles or patches in the Anteroposterior position 16- press (charge ) button and after you reach the desirable value press (deliver ) after you check the that everyone is clear Paddles shouldnt be too close 17- perform 12 lead ECG to document termination of tachyarrhythmia & restoration of SR after cardioversion Steps of giving cardioversion :-
  • 20. At which part of the ECG should it be delivered ? Absolute Refractory period Synchronized DC Shock DC Shock delivered on the complex (to avoid R on T phenomenon)
  • 21. At which part of the ECG should it be delivered ? Absolute Refractory period Synchronized DC Shock DC Shock delivered on the complex (to avoid R on T phenomenon)
  • 22. At which part of the ECG should it be delivered ? Absolute Refractory period Synchronized DC Shock DC Shock delivered on the complex (to avoid R on T phenomenon)
  • 23. At which part of the ECG should it be delivered ? Ventricular fibrillation
  • 24. Steps for giving Defibrillation (shockable rhythm ) A. start cardiac compressions immediately till another team member prepare for DC shocks B. the crash car with all the resuscitation equipment should be available C. Dont press the synchronization button D. put adequate amount of gel on the paddles E. put the paddles in an Anterolateral position F. adjust the joules at the maximum values in joules G. remove the ambu bag H. press (charge ) button and after you reach the desirable value press ( Deliver ) after you check that everyone is clear .
  • 25. What should I do immediately after giving DC shocks ? Defibrillation oresume the cardiac compressions immediately for two minutes before checking the rhythm othen check the rhythm after two minutes Cardioversion o check the rhythm on the monitor to detect whether the Shock was successful or not and whether he developed bradyasystole or VF that necessitate starting CPR
  • 26. Contraindications of DC Shock Defibrillation patient signed DNAR Cardioversion 1. atrial thrombosis 2. sinus rhythm 3. bradyasystole 4. automatic tachyarrhythmia (e.g. MAT or JT ) 5. digoxin toxicity (unless hemodynamically unstable) 6. patient cant be safely sedated 7. unknown duration of AF or flutter ( non anticoagulated patient in absence of TEE with no hemodynamically instability )
  • 27. Complications:- most common -harmless arrhythmia like atrial / ventricular premature beats Serious complications A) ventricular fibrillation B) thrombo-embolisation C ) myocardial necrosis D) myocardial stunning E ) pulmonary edema F) painful skin burns
  • 28. Cardioversion Vs Defibrillation a process of converting arrhythmia back to sinus rhythm SR it can be electrical (urgent ) or pharmacological (elective) delivery of DC Shock is synchronized to the QRS complex to prevent R on T phenomenon and triggering VF it is performed for 1- SVT 2- AF 3- atrial flutter 4- VT with social pulse ( hemodynamically stable or unstable) a process of immediate termination of VF using DC Shock only electrical (emergent ) delivery of DC Shock is not synchronized to the QRS complex due to absence of organized electrical activity its performed for 1- VF 2- Pulseless VT