In the name of God

دکتر علیرضا اسماعیلی استاد یارطب اورژانس DC SHOCK دکتر علیرضا اسماعیلی استاد یارطب اورژانس

Defibrillation is a nonsynchronized 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.

Indications Supraventricular tachycardia Atrial fibrillation Atrial flutter Ventricular tachycardia

Pulseless ventricular tachycardia (VT) Ventricular fibrillation (VF) Cardiac arrest due to or resulting in VF

Contraindications digitalis toxicity and catecholamine-induced arrhythmia Multifocal atrial tachycardia

Anesthesia Cardioversion is almost always performed under induction or sedation (short-acting agent such as midazolam)

Equipment Defibrillators Paddle adhesive patch Conductive gel or paste ECG monitor with recorder Oxygen equipment Intubation kit Emergency pacing equipment

Positioning Ant&post Ant&lat Ant&Rt Inf scapular Ant&lt Inf scapular

Monophasic vs biphasic waveforms Monophasic defibrillation delivers a charge in only one direction, biphasic defibrillation delivers a charge in one direction for half of the shock and in the electrically opposite direction for the second half. Biphasic waveforms defibrillate more effectively and at lower energies than monophasic waveforms

Synchronized electrical cardioversion begins with 25-50 treat atrial flutter 50-100 treat atrial fibrillation

Rapid polymorphic ventricular tachycardia (rate >150 bpm) associated with hemodynamic instability should be treated with immediate biphasic equivalent [100-200 J])

Monomorphic ventricular tachycardia should be treated with biphasic equivalent [50-100 J]. Ventricular fibrillation should be treated with unsynchronized electrical counter shock with biphasic equivalent [100-200 J].

Complications Atrial fibrillation Ventricular fibrillation Junctional premature beats ventricular fibrillation

Thromboembolization is associated with cardioversion in 1-3% of patients Myocardial necrosis can result from high-energy shocks Pulmonary edema is a rare complication of cardioversion Painful skin burns can occur after cardioversion or defibrillation

دستگاه بایفازیک با انرژی کمتر موفقیت بیشتر ویا مساوی از دستگاه مونو فازیک دارد

میزان شوک در اطفال 2j/kg 4j/kg

پدل نباید بر روی پچ ترانس درمال قرار گیرد

شوک بر روی یخ وبرف مانعی ندارد بیمار در آب وبیمار با تعریق فراوان نباید شوک داد.

اندازه پدل در بزرگسالان 8*12 است. هر چه پدل کوچکتر باشد شانس نکروز میوکارد بالا می رود.

فاصله بین پدل و ICD باید حداقل 8 سانتی متر باید باشد.

THE END thank you