DEFIBRILLATION

Ventricular Fibrillation is a very serious condition because the uncoordinated contractions of ventricular myocardium result in ineffective pumping. If immediate action is not taken the results are fatal.
In a person with ventricular fibrillation unconsciousness occurs rapidly, and CPR should be instituted without delay. Electrical defibrillation, by passage of current at high voltage, may be successful in restoration of a normal rhythm.

Defibrillation is the most effective treatment for ventricular fibrillation. The success of resuscitation of patients with ventricular fibrillation relates to how fast electrical defibrillation can be applied. The longer the duration of fibrillation, the greater the deterioration of the myocardium related to hypoxia as a fibrillating heart consumes a very large amount of oxygen. The chance of successful defibrillation is also reduced with the length of time fibrillating.

PROCEDURE FOR DEFIBRILLATION

Equipment Needed
  1.  Defibrillator
  2.  Gel Pads

Procedure Rationale

1.Identify ventricular fibrillation (VF) on the monitor. Check leads, confirm pulselessness. 1.No unnessary shock.

2.Call an arrest. 2.To obtain appropriate and adequate personnel to manage the airway, do chest compressions, and prepare and administer medications.

3.May "thump" the precardium. 3.May generate enough stiumulation to defibrillate the patient if done early in VF.

4.Initiate CPR until defibrillator available. 4.Maintain oxygenation/circulation to brain and heart. Defibrillate as soon as possible.

5.Prepare the machine for defibrillation:
_ Plug cart in.
_ Set charge at 300 joules.
_ If time allows, apply leads from cart monitor.
_ Set to "defibrillate"
5.Initial voltage of 200-300 joules (watts) is recommended by the AHA.
Establishment of fibrillation shouldn't delay defibrillation.
The defibrillator will not fire if the machine is on synch (for cardioversion).

6.Prepare patient for defibrillation:
_ side rail down
_ bed and patient flat
_ apply gel pads in correct position
one above, one below heart
at least 2 cm. away from electrodes.
6.Provide better access to patient.
Prevents burns from defibrillator. Reduces resistance of skin to the electrical current.
Current through myocardium will depolarize as much myocardium as possible.
- prevents arcing between paddles and electrodes and burning of patient.

7. Quick look at monitor while shouting all clear. 7.In the event of rhythm change.

8.Firmly press paddles onto gel pads and discharge by simultaneously depressingbuttons.
Be sure to depress buttons firmly and hold for 2 seconds.
Ensure no contact with metal on bed, all personal away from bed contact.
8.Two pounds pressure required to ensure contact.
To safely deliver charge.
Premature release of buttons may result in failure to discharge energy.

9.Reassess rhythm and pulse. 9.Assess response.

10.Recharge paddles. 10.Ready for repeat.

11.If VF persists, increase charge to maximum 360 joules and repeat. 11.The amount of energy needed to convert VF rapidly increases with time.
Chest wall resistance decreases with rapidly successive shocks. May be easier to defibrillate.

12.Administer lidocaine bolus, 1 mg/kg and start an infusion at 2 mg/min as per "L" Lidocaine, Administration Procedure. 12.To minimize recurrance. Defibrillate first to avoid delay in converting rhythm. Some studies have indicated that lidocaine may reduce responsiveness to defibrillation.

13.If unsuccessful:
Continue CPR
13.Troubleshoot for possible physical causes, eg., acidosis, hypoxia. Ensure adequate paddle pressure, machine off synchronization.

14.Obtain medical support STAT, may need to call second on-call
Safety to health care workers.
14.For medical intervention.

15.If successful:
_ maintain airway
_ ensure breathing
_ monitor circulation

15.Hypoxia or acidosis may be present. Ready for repeat.

16.Assess and treat for side effects: burns, arrhythmias, anxiety. 16.The amount of energy needed to convert VF rapidly increases with time.
Chest wall resistance decreases with rapidly successive shocks. May be easier to defibrillate.

17.Reassure patient, notify family. 17.To minimize recurrance. Defibrillate first to avoid delay in converting rhythm. Some studies have indicated that lidocaine may reduce responsiveness to defibrillation.

18.Document rhythm strips, graphics, shock and resuscitation record. 18.Troubleshoot for possible physical causes, eg., acidosis, hypoxia. Ensure adequate paddle pressure, machine off synchronization.

Procedure	Rationale
1.Identify ventricular fibrillation (VF) on the monitor. Check leads, confirm pulselessness.	1.No unnessary shock.
2.Call an arrest.	2.To obtain appropriate and adequate personnel to manage the airway, do chest compressions, and prepare and administer medications.
3.May "thump" the precardium.	3.May generate enough stiumulation to defibrillate the patient if done early in VF.
4.Initiate CPR until defibrillator available.	4.Maintain oxygenation/circulation to brain and heart. Defibrillate as soon as possible.
5.Prepare the machine for defibrillation: _ Plug cart in. _ Set charge at 300 joules. _ If time allows, apply leads from cart monitor. _ Set to "defibrillate"	5.Initial voltage of 200-300 joules (watts) is recommended by the AHA. Establishment of fibrillation shouldn't delay defibrillation. The defibrillator will not fire if the machine is on synch (for cardioversion).
6.Prepare patient for defibrillation: _ side rail down _ bed and patient flat _ apply gel pads in correct position one above, one below heart at least 2 cm. away from electrodes.	6.Provide better access to patient. Prevents burns from defibrillator. Reduces resistance of skin to the electrical current. Current through myocardium will depolarize as much myocardium as possible. - prevents arcing between paddles and electrodes and burning of patient.
7. Quick look at monitor while shouting all clear.	7.In the event of rhythm change.
8.Firmly press paddles onto gel pads and discharge by simultaneously depressingbuttons. Be sure to depress buttons firmly and hold for 2 seconds. Ensure no contact with metal on bed, all personal away from bed contact.	8.Two pounds pressure required to ensure contact. To safely deliver charge. Premature release of buttons may result in failure to discharge energy.
9.Reassess rhythm and pulse.	9.Assess response.
10.Recharge paddles.	10.Ready for repeat.
11.If VF persists, increase charge to maximum 360 joules and repeat.	11.The amount of energy needed to convert VF rapidly increases with time. Chest wall resistance decreases with rapidly successive shocks. May be easier to defibrillate.
12.Administer lidocaine bolus, 1 mg/kg and start an infusion at 2 mg/min as per "L" Lidocaine, Administration Procedure.	12.To minimize recurrance. Defibrillate first to avoid delay in converting rhythm. Some studies have indicated that lidocaine may reduce responsiveness to defibrillation.
13.If unsuccessful: Continue CPR	13.Troubleshoot for possible physical causes, eg., acidosis, hypoxia. Ensure adequate paddle pressure, machine off synchronization.
14.Obtain medical support STAT, may need to call second on-call Safety to health care workers.	14.For medical intervention.
15.If successful: _ maintain airway _ ensure breathing _ monitor circulation	15.Hypoxia or acidosis may be present. Ready for repeat.
16.Assess and treat for side effects: burns, arrhythmias, anxiety.	16.The amount of energy needed to convert VF rapidly increases with time. Chest wall resistance decreases with rapidly successive shocks. May be easier to defibrillate.
17.Reassure patient, notify family.	17.To minimize recurrance. Defibrillate first to avoid delay in converting rhythm. Some studies have indicated that lidocaine may reduce responsiveness to defibrillation.
18.Document rhythm strips, graphics, shock and resuscitation record.	18.Troubleshoot for possible physical causes, eg., acidosis, hypoxia. Ensure adequate paddle pressure, machine off synchronization.