1. In the name of God

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

3. Defibrillation is a nonsynchronized delivery of energy during any phase of the cardiac cycle

4. cardioversion is the delivery of energy that is synchronized to the large R waves or QRS complex.

5. Indications Supraventricular tachycardia Atrial fibrillation
Atrial flutter
Ventricular tachycardia

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

7. Contraindications
digitalis toxicity and catecholamine-induced arrhythmia
Multifocal atrial tachycardia

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

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

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

11. 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

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

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

14. 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 [ J].

15. Complications Atrial fibrillation Ventricular fibrillation
Junctional premature beats
ventricular fibrillation

16. 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

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

18. میزان شوک در اطفال
2j/kg
4j/kg

19. پدل نباید بر روی پچ ترانس درمال قرار گیرد

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

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

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

23. THE END thank you