Friday, October 24, 2008

Cardioversion and defibrillation

Cardioversion and defibrillation is an electrical therapy to treat arrhythmias. Cardioversion refers to passage of electrical current across the heart usually synchronized to electrocardiogram. To revert supra ventricular tachycardia or ventricular arrhythmias, atrial flutter, atrial fibrillation, non pulse less VT.

Defibrillation refers to refers to passage of high dose electrical current to treat ventricular fibrillation. It applied during emergency situation as treatment for ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation depolarize a critical mass of myocardial cell, at once, when its repolarize the sinus node usually recapture its role as the pace maker.
The electrical voltage required to defibrillate the heart usually greater then require for cardioversion. If three defibrillation of increasing voltage have been unsuccessful cardio pulmonary resuscitation is initiated and advance life support are begun.

The use of epinephrine or vasopressin will make its easier to convert the dysrythmias to a normal rhythm. These drug also increase cerebral and coronary artery blood flow. Together with cardio pulmonary resuscitation for 1 minute, again defibrillations administer, to convert to sinus rhythm.
Then start, antiarrythmatic medication such as amiodarone (codarone) ,lidocaine(xylocaine) Magnesium or procainamide(magnesium dyhyrogenase Phosphates) and treatment continued until the stable rhythm resumes.

Responsibility during this procedure
It is nursing responsibility to ensure that any time the unit is ready. They must know color code for emergency and alert nursing team and doctor when its occur. Usually color code for emergency is code BLUE and for fire is code RED.

Before procedure.
It is nursing responsibility to ensure privacy for patient then to give CPR for 2 minute 30:2 before defibrillation and supply of oxygen is 100%.
Ensure the place secure from danger such as leaking oxygen source, water and inflammable items to prevent any sparks from poorly applied, defibrillator catches fire.


During the procedure
Ensure the place of electrode applies clean and not hairy if to hairy it should be shave to ensure good conduction and easy for the electrode to be apply and also easy and not painful for the patient when it need to be remove.
Ensure the suitable paddle force for adult 8 kg and for children 1- 8 years is 5 kg. ensure water gel pad place between the paddle and the patient skin it is to prevent the patient skin to be burn
Ensure the correct electrode position; place the right electrode to the right of the sternum below the clavicle, the apical paddle is placed vertically in the mid axillary line, approximately with the V6 ECG .

For female do not place the electrode on the breast tissue. It will cause patient to be uncomfortable and improper, instead of poor conduction and also may burn the patient skin.
Antero –posterior electrode placement is more effective than the traditional Antero-Apical position in cardioversion of atrial fibrillation.

Ensure again the rhythm whether is asystole or fine VF (ventricular Fibrillation) . Continue chest compression in case its revert back to sinus rhythm defibrillations should be terminated.

During defibrillation, monitor heart rhythm, oxygen saturation and hemodynamic of the patient to prevent patient from hypoxia.
Administer drug require in emergency such as Atropine 1 mg/ml and Adrenaline 1 mg/ml to stimulate cardiac output , Sodium Bicarbonate and etc.
Then start, antiarrythmatic medication such as amiodarone (codarone) ,lidocaine(xylocaine) Magnesium or procainamide(magnesium dyhyrogenase Phosphates) and treatment continued until the stable rhythm resumes.

Post resuscitation
One revert to sinus rhythm, monitor patient closely, and perform 12 lead ECG to monitor cardiac activity and abnormality to observe final outcome.
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