Defibrillation

Aka: Defibrillation, Unsynchronized Shock, Double Simultaneous Defibrillation, Dual Simultaneous Defibrillation

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II. Indications

  1. Ventricular Fibrillation
  2. Pulseless Ventricular Tachycardia

III. Precautions

  1. Avoid placing Defibrillator pads directly over cardiac Defibrillators or Pacemakers
  2. Attempt removal of metal piercings and jewelry if no delays

IV. Types

  1. Monophasic
    1. Shock one-way travels from one electrode to another
  2. Biphasic
    1. Shock round-trip travels from one electrode to another and back again

V. Doses

  1. Pediatric
    1. Initial: 2-4 J/kg
    2. Subsequent: 4 J/kg
    3. May increase up to 10 J/kg (or maximum adult dose)
  2. Adult
    1. Monophasic: Start 200 J (may increase to 300 J, then 360 J)
    2. Biphasic: Start 120-200 J (use manufacturers recommendations per specific device)

VI. Technique: Pearls for successful Defibrillation

  1. Successful Defibrillation of Ventricular Fibrillation requires Defibrillation of 95% of the heart
  2. Lateral pad placement over the cardiac apex is important for success
  3. Reduce impedence (minimize barriers to electrical transmission)
    1. Stop bag-valve-mask during Defibrillation (air in chest increases impedence)
    2. Dry a diaphoretic patient
    3. Shave excessive hair interfering with transmission
  4. Optimize perfusion
    1. Optimal Chest Compressions
    2. Epinephrine
  5. Consider external Dual Simultaneous Defibrillation
    1. See below
  6. References
    1. Shinar and Cheskes in Herbert (2016) EM:Rap 16(6): 5-6

VII. Technique: Dual Simultaneous Defibrillation

  1. Definition
    1. Two Defibrillators attached to chest for simultaneous shock
    2. Doubles current delivered to the heart
  2. Protocol
    1. Apply a second set of Defibrillator pads
    2. Second pad positions
      1. Adjacent to first set (e.g. right parasternal and cardiac apex) or
      2. Opposite positions (e.g. anterior-posterior)
    3. Charge each Defibrillator
    4. Clear all staff from touching patient before discharge
    5. Deliver shocks simultaneously
  3. References
    1. Warrington (2017) Crit Dec Emerg Med 31(8): 23
    2. Cheskes (2020) Resuscitation 150:178-84 +PMID:32084567 [PubMed]

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Related Studies

Ontology: Electric Countershock (C0013778)

Definition (CHV) a method to restore a rapid heart beat back to normal using electric shock or medications
Definition (CHV) a method to restore a rapid heart beat back to normal using electric shock or medications
Definition (CHV) a method to restore a rapid heart beat back to normal using electric shock or medications
Definition (CHV) a method to restore a rapid heart beat back to normal using electric shock or medications
Definition (NCI_CDISC) The administration of electric current to correct abnormal heart rhythm.
Definition (NCI) The administration of electric current to correct abnormal heart rhythm. (ACC)
Definition (NCI) The conversion of one cardiac rhythm or electrical pattern to another, almost always from an abnormal to a normal one, by pharmacologic means using medications or by electrical cardioversion using a defibrillator.
Definition (CSP) electric shock applied to the heart to terminate a disturbance of its rhythm, or to resuscitate.
Definition (MSH) An electrical current applied to the HEART to terminate a disturbance of its rhythm, ARRHYTHMIAS, CARDIAC. (Stedman, 25th ed)
Concepts Therapeutic or Preventive Procedure (T061)
MSH D004554
ICD9 99.6
ICD10 13400-00
SnomedCT 250980009, 150917000, 266800004, 150923005, 287700005, 180324004, 74088007, 180325003
LNC LP97905-1
English Cardiac Electroversion, Cardiac Electroversions, Cardioversion, Cardioversions, Countershock, Electric, Countershocks, Electric, Defibrillation, Electric, Defibrillations, Electric, Electric Countershocks, Electric Defibrillation, Electric Defibrillations, Electroversion, Cardiac, Electroversions, Cardiac, electric countershock heart resuscitation, Electrical cardioversion NOS, defibrillation (treatment), defibrillation, Defibrillation, cardioversions, Cardioversion;arrhythmia, cardioversion, electric countershock, Electric Countershock, Electric Cardioversion, Cardioversion -electric, Electrical cardioversion (& defibrillation), Electrical cardioversion NOS (procedure), Cardioversion and stimulation, Electrical cardioversion (& defibrillation) (procedure), Electric countershock, ELECTRICAL CARDIOVERSION, CARDIOVERSION, ELECTRICAL, Conversion of cardiac rhythm, Electrical cardioversion, Cardioversion (procedure), Cardiac countershock, NOS, Conversion of cardiac rhythm, NOS, Cardiac countershock, Cardioversion (procedure) [Ambiguous], cardiac electroversion, Cardioversion, NOS
Dutch defibrillatie, elektrische cardioversie, cardioversie, Cardioversie, Cardioversie, elektrische, Defibrillatie, elektrische, Elektrische cardioversie
Portuguese Desfibrilhação, Cardioversão eléctrica, Cardioversão Elétrica, Cardioversão, Desfibrilação Elétrica, Eletroversão Cardíaca
Spanish Desfibrilación, Desfibrilación Eléctrica, Cardioversión eléctrica, cardioversión eléctrica, SAI (procedimiento), cardioversión eléctrica, SAI, shock cardíaco, Electrical cardioversion NOS, cardioversión (concepto no activo), cardioversión (procedimiento), cardioversión eléctrica, cardioversión, conversión del ritmo cardíaco, Cardioversión, Cardioversión Eléctrica, Electroversión Cardíaca
Japanese 除細動, ｼﾞｮｻｲﾄﾞｳ, ﾃﾞﾝｷﾃｷｼﾞｮｻｲﾄﾞｳ, ｼﾝｿﾞｳｼﾞｮｻｲﾄﾞｳ, 心臓除細動, カウンターショック, 電気的除細動, カルジオバージョン, 直流電撃療法, 除細動-電気的, 電気カウンターショック, 電気除細動
Swedish Hjärtdefibrillering
Czech kardioverze elektrická, elektrická defibrilace, Elektrická kardioverze, Defibrilace, Kardioverze
French Cardioversion électrique, Défibrillation, Cardioversion, Choc électrique externe, CEE (Choc Électrique Externe), Défibrillation électrique
German elektrische Kardioversion, Defibrillation, elektrische, Elektrokonversion, kardiale, Kardiale Elektrokonversion, Kardioversion, Defibrillation
Italian Cardioversione elettrica, Defibrillazione elettrica, Cardioversione, Elettroversione cardiaca, Defibrillazione
Finnish Sähköinen rytminsiirto
Russian KARDIOVERSIIA, ELEKTROIMPUL'SNAIA TERAPIIA, DEFIBRILLIATSIIA ELEKTRICHESKAIA, KARDIOSTIMULIATSIIA ELEKTROSHOKOM, ДЕФИБРИЛЛЯЦИЯ ЭЛЕКТРИЧЕСКАЯ, КАРДИОВЕРСИЯ, КАРДИОСТИМУЛЯЦИЯ ЭЛЕКТРОШОКОМ, ЭЛЕКТРОИМПУЛЬСНАЯ ТЕРАПИЯ
Croatian ELEKTROKONVERZIJA
Polish Kardiowersja i defibrylacja
Hungarian Defibrillálás, Cardioversio, Elektromos cardioversio
Norwegian Elektrokonvertering, Elektrisk defibrillering, Kardial elektroversjon, Kardioversjon
Derived from the NIH UMLS (Unified Medical Language System)

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