Defibrillation (redirected from Defib)

Defibrillation 

Definition

Defibrillation is a process in which an electronic device sends an electric shock to the heart to stop an extremely rapid, irregular heartbeat, and restore the normal heart rhythm.

Purpose

Defibrillation is performed to correct life-threatening fibrillations of the heart, which could result in cardiac arrest. It should be performed immediately after identifying that the patient is experiencing a cardiac emergency, has no pulse, and is unresponsive.

Precautions

Defibrillation should not be performed on a patient who has a pulse or is alert, as this could cause a lethal heart rhythm disturbance or cardiac arrest. The paddles used in the procedure should not be placed on a woman's breasts or over a pacemaker.

Description

Fibrillations cause the heart to stop pumping blood, leading to brain damage and/or cardiac arrest. About 10% of the ability to restart the heart is lost with every minute that the heart stays in fibrillation. Death can occur in minutes unless the normal heart rhythm is restored through defibrillation. Because immediate defibrillation is crucial to the patient's survival, the American Heart Association has called for the integration of defibrillation into an effective emergency cardiac care system. The system should include early access, early cardiopulmonary resuscitation, early defibrillation, and early advanced cardiac care.

Defibrillators deliver a brief electric shock to the heart, which enables the heart's natural pacemaker to regain control and establish a normal heart rhythm. The defibrillator is an electronic device with electrocardiogram leads and paddles. During defibrillation, the paddles are placed on the patient's chest, caregivers stand back, and the electric shock is delivered. The patient's pulse and heart rhythm are continually monitored. Medications to treat possible causes of the abnormal heart rhythm may be administered. Defibrillation continues until the patient's condition stabilizes or the procedure is ordered to be discontinued.

Early defibrillators, about the size and weight of a car battery, were used primarily in ambulances and hospitals. The American Heart Association now advocates public access defibrillation; this calls for placing automated external defibrillators (AEDS) in police vehicles, airplanes, and at public events, etc. The AEDS are smaller, lighter, less expensive, and easier to use than the early defibrillators. They are computerized to provide simple, verbal instructions to the operator and to make it impossible to deliver a shock to a patient whose heart is not fibrillating. The placement of AEDs is likely to expand to many public locations.

Preparation

After help is called for, cardiopulmonary resuscitation (CPR) is begun and continued until the caregivers arrive and set up the defibrillator. Electrocardiogram leads are attached to the patient's chest. Gel or paste is applied to the defibrillator paddles, or two gel pads are placed on the patient's chest. The caregivers verify lack of a pulse, and select a charge.

Aftercare

After defibrillation, the patient's cardiac status, breathing, and vital signs are monitored until he or she is stable. Typically, this monitoring takes place after the patient has been removed to an intensive care or cardiac care unit in a hospital. An electrocardiogram and chest x ray are taken. The patient's skin is cleansed to remove gel or paste, and, if necessary, ointment is applied to burns. An intravenous line provides additional medication, as needed.

Risks

Skin burns from the defibrillator paddles are the most common complication of defibrillation. Other risks include injury to the heart muscle, abnormal heart rhythms, and blood clots.

Resources

Organizations

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. http://www.americanheart.org.

Key terms

Cardiac arrest — A condition in which the heart stops functioning. Fibrillation can lead to cardiac arrest if not corrected quickly.

Fibrillation — Very rapid contractions or twitching of small muscle fibers in the heart.

Pacemaker — A surgically implanted electronic device that sends out electrical impulses to regulate a slow or erratic heartbeat.

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defibrillation /de·fib·ril·la·tion/ (de-fib?ri-la´shun) termination of atrial or ventricular fibrillation, usually by electroshock.

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de·fib·ril·la·tion (d-fbr-lshn, -fbr-)

n.

The stopping of fibrillation of the heart muscle and the restoration of normal contractions using drugs or electric shock.

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de·fibril·late v.

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defibrillation (dēfib´rilāshn),

n the arrest of fibrillation, usually that of the cardiac ventricles. An intense alternating current is briefly passed through the heart muscle, throwing it into a refractory state.

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defibrillation

1. termination of atrial or ventricular fibrillation, usually by electric shock.

2. separation of tissue fibers by blunt dissection.

Defibrillation by precordial shock is accomplished by delivering a nonsynchronized direct current to the myocardium. It is an emergency procedure, used to terminate a life-threatening ventricular arrhythmia. The electric shock is delivered by means of metal paddles applied directly to the heart muscle, as in cardiac surgery, or by placing the paddles on the chest (closed defibrillation).

The high-voltage electrical current delivered during precordial shock causes complete depolarization of the heart muscle, disrupting all of the electrical circuits that are activating the heart muscle and causing ventricular fibrillation. This allows the heart's natural pacemaker to regain control and regulation of the heart rate and rhythm.

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chemical defibrillation

where electrical equipment is not available for defibrillation, some combinations of drugs have been used. These include potassium chloride followed by calcium chloride or potassium chloride and acetylcholine.

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defibrillation Cardiac pacing The termination of unsynchronized quivering of the ventricular myocardium by discharging a high energy, asynchronous electrical stimulus to the myocardium; the defibrillatory discharge often restores normal rhythm. See Low-energy defibrillation.