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Cardiac Defibrillator

Nihon Kohden 2008

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Contents
Main Functions of a Defibrillator Fibrillation Defibrillation Arrhythmias Requiring Defibrillation Defibrillation and Cardioversion Cardioversion AED (Automated External Defibrillation) Monitoring

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Main Functions of a Defibrillator


Defibrillation (most important) Cardioversion (synchronized defibrillation)

Monitoring

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Fibrillation
Fibrillation = Cardiac muscle cells are excited randomly. = Heart muscle spasms = Quivering instead of pumping

Decreased pump function No circulation of blood Cardiac Arrest Defibrillation by large current!!

Alive Death

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Fibrillation
ECG waveform of Ventricular fibrillation (Vf)

No P, QRS, T-waves = No heart beat Irregular Shape, Amplitude and Rate

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Defibrillation
Defibrillation delivers an electrical shock to stop fibrillation and convert the abnormal rhythm to a normal rhythm. = A large current shock normalizes the muscle excitability phases. = This stops the fibrillations and restores the normal rhythm.

(Image)

Defibrillation (large current shock)

Random excitement Reset the rhythm

Normal rhythm

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Arrhythmias Requiring Defibrillation


1. Af (Atrial Fibrillation)

2. AFL (Atrial Flutter)


3. VT (Ventricular Tachycardia) 4. VF (Ventricular Fibrillation)

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Arrhythmias Requiring Defibrillation


Atrial Fibrillation (Af)
/ f-wave

P-wave is missing

Irregular R-R

f-waves on the baseline No P-wave Irregular R-R Reduced pumping

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Arrhythmias Requiring Defibrillation


Atrial Flutter (AFL)
F-wave Irregular R-R

No P-wave

f-waves on the baseline No P-wave Irregular R-R Reduced pumping

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Arrhythmias Requiring Defibrillation


Ventricular Tachycardia (VT)

Very serious condition

Sudden excitement goes around the Re-entry Circuit Only ventricular contraction Greatly decreased cardiac output, depending on the HR Wide QRS, high heart rate, regular R-R, No P-wave

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Arrhythmias Requiring Defibrillation


Ventricular Fibrillation (VF)

Fatal condition. Needs immediate defibrillation!!

Irregular excitement everywhere in the ventricles Just quivering, no contraction No cardiac output, no circulation

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Defibrillation & Cardioversion VF / pulse-less VT


Af / AFL
Why?

Defibrillation

Cardioversion

= Defibrillation should be synchronized with R-wave. To prevent R on T R on T? If the stimulation is given on the T-wave, the heart will go to VF.

Very dangerous!!!!! Shock on T VF

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Cardioversion
Shock in synchronization with R-wave

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AED Automated External Defibrillation


When shockable waveform (VF) occurs,

Defibrillator detects the shockable waveform (VF)


and charges energy automatically

Discharge by manually !