Defibrillation

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See critical care quick reference for defibrillation settings (joules) by weight.

Indications

It is important to note that the procedure for and indications differ between defibrillation and cardioversion

Defibrillation (Unsynchronized cardioversion)

Synchronized Cardioversion

Contraindications

  • None

Equipment Needed

  • Automated External Defibrillator (AED)
  • Defibrillator

Procedure

  • Apply pads or paddles
    • Paddles may be slightly quicker but pads are viewed to be safer[1]
  • Larger pads reduce transthoracic impedance[2]
    • “Adult” size in adults
    • “Adult” size (8 to 10 cm) for children >10 kg (> approximately 1 year)[3]
    • “Infant” size for infants <10 kg
  • 4 accepted pad positions: anterolateral, anteroposterior, anterior-left infrascapular, and anterior-right-infrascapular
    • Anteroposterior position performs slightly better[4]
  • Biphasic setting
    • Initial 120-200J for VF/pulseless Vtach in adults (Monophasic 360J)[5]
    • Initial 2-4J/kg (Do not exceed J/kg) for pediatric VF/pulseless Vtach[6]

Complications

  • Defibrillator Refractory VF
    • Consider apply 2 defibrillators and delivering double sequential external shocks[7][8]

See Also

External Links

References

  1. Benedikte H, et al. Time and safety in defibrillation with paddles versus pads: A comparative study of two defibrillation regimes. Resuscitation. 2013; 84(11):e141–e142.
  2. Connell PN, et al. Transthoracic impedance to defibrillator discharge. Effect of electrode size and electrode-chest wall interface. J Electrocardiol. 1973; 6:313–M.
  3. Atkins DL, et al. Pediatric defibrillation: current flow is improved by using “adult” electrode paddles. Pediatrics. 1994; 94:90–93.
  4. Krasteva V, et al. Transthoracic impedance study with large self-adhesive electrodes in two conventional positions for defibrillation. Physiol Meas. 2006; 27:1009–1022.
  5. Neumar RW, et al. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. Part 8: Adult Advanced Cardiovascular Life Support. Circulation. 2010; 122: S729-S767.
  6. Kleinman ME, et al. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. Part 14: Pediatric Advanced Life Support. Circulation. 2010; 122: S876-S908.
  7. Hoch DH, et al. Double sequential external shocks for refractory ventricular fibrillation. J Am Coll Cardiol. 1994; 23(5):1141-5.
  8. Cabanas JG, et al. Double Sequential External Defibrillation in Out-of-Hospital Refractory Ventricular Fibrillation: A Report of Ten Cases. Prehosp Emerg Care. 2015; 19(1):126-130.

Authors:

Neil Young