1. Defibrillation & Cardioversion
By Dr Hicham Al Mawla
EMJ
Lebanon

2. Definition of Cardioversion
Cardioversion is a method to restore
a rapid heart beat back to normal .
Cardioversion is used in
persons who have heart rhythm
problems (arrhythmias), which can
cause the heart to beat too fast.

4. Cardioversion
Most elective or non-emergency Cardioversions are performed :
To treat atrial fibrillation or atrial flutter to regain heart rhythm.
To treat disturbances originating in the upper
Chambers (atria) of the heart.

5. Cardioversion Cardioversion is used in emergency
situations to correct a rapid abnormal
rhythm associated with faintness,
low blood pressure, chest pain,
difficulty breathing, or loss of
consciousness.

6. Types Of Cardioversion
Cardioversion can be "chemical" or
"electrical".
Chemical cardioversion: refers to the use of antiarrhythmia medications
to restore the heart's normal rhythm.

7. Types Of Cardioversion
Electrical cardioversion : (also known
as " direct-current" or DC cardioversion);
is a procedure whereby a synchronized
electrical shock is delivered through the chest
wall to the heart through special electrodes
or paddles that are applied to the skin
of the chest and back.

8. .

9. The goals of the electrical cardioversion
Is to disrupt the abnormal electrical circuit(s) in the heart.
To restore a normal heart beat .

10. Pharmacologic Cardioversion
Cardioversion can be done using drugs
that are taken by mouth or given through
an intravenous line (IV).
It can take several minutes to days for a
successful cardioversion.

11. Pharmacologic Cardioversion
If pharmacological cardioversion is done in
a hospital, your heart rate will be regularly
checked.
Cardioversion using drugs can be done outside the hospital, but this requires close follow-up with a cardiologist.

12. Pharmacologic Cardioversion
Blood thining medicines may be given
with electrical cardioversion to prevent
clots from moving to the heart.

13. Complications Possible complications of cardioversion
are uncommon but may include:
Worsening of the arrhythmias .
Blood clots that can cause a stroke or other organ damage, bruising, burning or pain where the paddles were used.
Allergic reactions from medicines used in pharmacologic cardioversion .

14. Equipment Defibrillator with a synchronising button.
Emergency trolley with emergency drugs;
( lignocaine, atropine, and adrenaline ).
Oxygen mask, intubation equipment, airway .
Monitor and continuous recording facilities.

15. Preparing for a Cardioversion
Do not eat or drink for at least eight hours prior to the procedure.
Take your regularly scheduled medications the morning of the procedure unless your medical practitioner has told you otherwise .
Bring a list of all your medications with you.

16. Preparing for a Cardioversion
Do not apply any lotions or ointments to chest or back as this may interfere with the adhesiveness of the shocking pads.
Do not drive yourself home after receiving sedation anesthesia.

17. Preparing for a Cardioversion
Do not operate a car, heavy machinery, or make any important decisions.
Stop digoxin before 48 hours prior the procedure.
Apply ointment to the area to reduce the discomfort.

18. Outcome a successful reversion to sinus rhythm or
The procedure will be terminated either by
a successful reversion to sinus rhythm or
when the medical officer determines that
cardioversion will not revert the rhythm.

19. Defibrillation
Is a medical technique used to counter the onset of ventricular fibrillation, a common cause of cardiac arrest, and pulseless ventricular tachycardia,
In simple terms, the process uses an electric shock to stop the heart arrhythmias, in the hope that the heart will restart with rhythmic contractions.

20. History Of Defibrillation
Defibrillation was invented in 1899 by Prevost
and Batelli, two Italian physiologists. They
discovered that electric shocks could convert
ventricular fibrillation to sinus rhythm in dogs.
The first case of a human life saved by
defibrillation was reported by Beck in 1947.

21. The Purpose Of Defibrillation
Is to apply a controlled electrical
shock to the heart, which leads to
depolarization of the entire electrical
conductive system of the heart.

22. Types of Defibrillators
Internal Defibrillators
The device may be implanted directly in the user of the device.
So it is known as an Impalantable cardioverter-defibrillator or (much less frequently) an internal cardiac defibrillator (ICD).
This type of defibrillator is designed to provide immediate defibrillation to high-risk patients .

23. Implantable Cardioversion Defibrillation
An implantable cardioverter-defibrillator (often called an ICD) is a device that briefly passes an electric current through the heart. It is "implanted," or put in your body surgically. It includes a pulse generator and one or more leads. The pulse generator constantly watches your heartbeat.

24. Types of Defibrillators
Automated External defibrillator (AEDs)
External defibrillators are typically used in hospitals or ambulances, but are increasingly common outside the medical areas .
As automated external defibrillators become safer and cheaper.

25. Methods Of Defibrillation
The shock is generally conducted through the heart by two electrodes, in the form of two hand-held paddles or adhesive patches depending on the variety of the defibrillator.

26. Methods Of Defibrillation
One electrode is placed on the right side of the front of the chest just below the clavicle.
The other electrode is placed on the left side of the chest just below the pectoral muscle of breast.

28. Methods Of Defibrillation
Open-chest defibrillators also exist, which have electrodes in the form of two cup-shaped paddles that surround the sides of the heart and shock it directly.
Open-chest defibrillators generally require less energy to operate due to direct contact with the heart .

29. Methods Of Defibrillation
The number of attempts is in practice limited to a series of three or four attempts at increasing energies.
The likelihood of restoring normal heart rhythm is much less in successive attempts.

32. Differences Between Cardioversion & Defibrillation
One major difference between cardioversion
and defibrillation with the timing of the delivery of electrical current .
Another major difference concerns the
circumstance defibrillation usually performed
as an emergency treatment .
Cardioversion is usually, but not always a planned procedure .

33. Procedure The most well-known type of electrode is the
traditional metal paddle with an insulated handle.
This type must be held in place on the
patient's skin while a shock or a series of
shocks is delivered.

34. Procedure Steps
Place paddles so that they do not touch pts clothing or bed linens or not near direct oxygen supply.
Ensure monitor is attached to pat.
Do not charge the machine untill ready to shock.

35. Procedure Exert 25 pound pressure on the paddle .
Ensure you and every body is free of the pat.Inspect skin for burns.
Record the delivered energy.

37. Treatment Shock may be delivered, but it is not
regarded as the treatment of choice.
Antiarrhthmic medications such as
amiodarone, cordorone, lidocaine,
magnesium, or pronestly are given if
ventricular dysrhythmia persists.

38. Treatment The probability of a successful conversion is
very small according to the current
guidelines, in this situation, continued CPR in
order to improve the oxygenation of the heart
for a few minutes is preferred before
defibrillation is attempted . .

39. Warning As the nurse applies the shock this is just
a warning to everyone around to stay away from the patient for risk of
electrical shock.

40. THANK YOU