//fpnotebook.com/
Defibrillation
Aka: Defibrillation, Unsynchronized shock
- See Also
- Defibrillator Equipment
- Synchronized Cardioversion
- Indications
- Ventricular Fibrillation
- Pulseless Ventricular Tachycardia
- Types
- Monophasic
- Shock one-way travels from one electrode to another
- Biphasic
- Shock round-trip travels from one electrode to another and back again
- Doses
- Pediatric
- Initial: 2-4 J/kg
- Subsequent: 4 J/kg
- May increase up to 10 J/kg (or maximum adult dose)
- Adult
- Monophasic: Start 200 J (may increase to 300 J, then 360 J)
- Biphasic: Start 120-200 J (use manufacturers recommendations per specific device)
- Technique: Pearls for successful Defibrillation
- Successful Defibrillation of Ventricular Fibrillation requires Defibrillation of 95% of the heart
- Lateral pad placement over the cardiac apex is important for success
- Reduce impedence (minimize barriers to electrical transmission)
- Stop bag-valve-mask during Defibrillation (air in chest increases impedence)
- Dry a diaphoretic patient
- Shave excessive hair interfering with transmission
- Optimize perfusion
- Optimal Chest Compressions
- Epinephrine
- Consider double sequential external Defibrillation
- Two Defibrillators attached to chest for simultaneous shock
- Doubles current delivered to the heart
- References
- Shinar and Cheskes in Herbert (2016) EM:Rap 16(6): 5-6