DEFIBRILLATION

DEFINITION:
Electric current is delivered through the chest to the heart. The flow of
current through the heart causes depolarization of the myocardial cells.
Ideally, a normal underlying heart rhythm will then resume. This energy
charge is delivered from the defibrillator capacitor through either metal
paddles or adhesive patches (hands free).
DEFIBRILLATION SUCCESS
Successful defibrillation depends upon the following:
Time to the first shock
o Survival declines 7-10% each minute from collapse to the first
shock if no CPR is performed.
o Deliver the first shock as quickly as possible for a witnessed
arrest.
Effective CPR
o Survival decreases-3-4% each minute from arrest to the first
shock if CPR is performed.
o Perform CPR for 2 minutes before defibrillation if the arrest is
unwitnessed.
An effective level of energy delivery
o The amount of energy needed to defibrillate varies according to
the defibrillation waveform.
DEFIBRILLATION TECHNIQUE
The technique for defibrillation will vary depending on whether you are
using manual paddles or self-adhesive (hands-free) defibrillation patches.
The two most common methods ate the use of manual paddles and handsfree defibrillation.
WARD BASED MODULE
phone: 555.555.5555 | fax: 555.555.5555 | Kwaifyah, Benghazi | www.nursingcollegebenghazi.com

A. Defibrillation using Manual Paddle

WARD BASED MODULE

B. Defibrillation using Hands-free Patches

DEFIBRILLATION INDICATIONS AND ENERGY LEVELS

INDICATIONS:
1. Pulseless ventricular tachycardia.
2. Ventricular fibrillation.
3. Hemodynamically unstable polymorphic ventricular tachycardia.
ENERGY LEVELS:
Monophasic defibrillator: 360 J
Biphasic

defibrillator:

120-200

(based

on

the

manufacturers

recommendations)
IMPLEMENTATION:
ACTION
DEFIBRILLATION

RATIONALE
USING

MANUAL PADDLES:
1. Turn

on

the

power

to

monitor/defibrillator

the To ensure that the machine is working

properly.

2. Determine that the rhythm is Determining the heart rhythm ensure

ventricular

fibrillation(VF)

or the proper use of the machine.

ventricular tachycardia(VT)
3. Verify that the patient has no To continue the procedure.
pulse.
4. Apply conduction gel to the This prevents burning the skin of the
paddles or pre-gelled conduction patient.
WARD BASED MODULE

pads to the patients chest.

5. Select

the

appropriate

energy This will effectively help the client in

level.
restoring the conditions.
6. Place the paddles on the patients
chest.
Anterior-anterior (sternum-apex):

Proper

placement

of

the

paddles

Place the sternum paddle below ensures effective defibrillation to client.

the right clavicle. Place the apex
paddle in the left midaxillary line
to the left of the nipple.
7. Apply firm pressure.
Ensure effective treatment.
8. Press the charge button while For effective defibrillation.
reassessing the rhythm.
9. Call Im clear, youre clear, To ensure that no one is touching the
everyone is clear! while looking patient.
head to toe.
10.Resume CPR
To revive the client.
11.Check the rhythm after 2-cycles of To flow the current through the heart
CPR and defibrillate again if causing
indicated.
HANDS-FREE DEFIBRILLATION
1. Turn

on

the

power

to

depolarization

of

the

myocardial muscles

the To ensure that the machine is working

monitor/defibrillator
properly.
2. Determine that the rhythm is Determining the heart rhythm ensure
ventricular

fibrillation(VF)

or the proper use of the machine.

ventricular tachycardia(VT)
3. Verify that the patient has no To continue the procedure.
pulse.
4. Place the adhesive defibrillation

WARD BASED MODULE

pads on the patients chest in the

anterior-anterior

(sternum-apex) Proper

placement

of

the

paddles

position or in the anterior-posterior ensures effective defibrillation to client.

position.
Anterior-posterior patch position:
Place one patch over the apex of
the heart (the center should be
over

the

point

of

maximal

impulse). Place the second patch

on the patients back, directly
opposite the first and to the left of
the thoracic spine.
5. Connect the adhesive pads to the To ensure effective treatment.
defibrillation cable and ensure that
the cable is connected to the
monitor/defibrillator.
6. Select the appropriate

energy This will effectively help the client in

level.
restoring the conditions.
7. Press the charge button while For effective defibrillation.
reassessing the rhythm.
8. Call Im clear, youre clear, To ensure that no one is touching the
everyone is clear! while looking patient.
head to toe.
9. Resume CPR
To revive the client.
10.Check the rhythm after 2-cycles of To flow the current through the heart
CPR and defibrillate again if causing
indicated.

WARD BASED MODULE

depolarization

myocardial muscles

of

the

NOTE:
First, DO NO HARM! You must be sure that neither you nor any of
your teammates are touching the patient when you defibrillate.
Dont stop CPR while the defibrillator pads are applied or during the
time the defibrillator is charging.
References:
American Heart Association, AHA Guidelines for Cardiopulmonary Resuscitation and
Emergency Cardiovascular Care, Circulation 112, suppl. 1 (2005).
McKenna, K. ACLS Essentilas, Basic and More, McGraw-Hill Companies, Inc., 2008,
p.12-18

WARD BASED MODULE