DEFIBRILLATION,
CARDIOVERSION AND
PACINGBy: dr ismah, A&E department
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Defibrillation
History
1900 defibrillation discovery
1947 human defibrillation
1967 successful outside hospital defibrillation
For VF or pulseless VT
Defibrillation (shock success) termination of
VF for at least 5s following shock
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Types 8
http://www.resuscitationcentral.com/
360J 200J
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Sternum
Apex
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Automated AED @ KLIA
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Cardioversion
Alive, unstable, tachyarrhythmia
Unstable?
- Signs of low cardiac output: systolic hypotension
< 90 mmHg, altered mental status
- Excessive rates >150/min
- Chest pain
- Heart failure
Synchronized cardioversion is shock
delivery that is timed (synchronized) with
the QRS complex
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Conditions Starting J
(monophasic)
AF 200
Atrial flutter 100
VT 200
SVT 100
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Defibrillation Cardioversion
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PacingUnstable, bradyarrhythmias/bradycardia
Symptomatic sinus bradycardia
Heart block
- Complete heart block
- Mobitz type II 2nd degree heart block
Transcutaneous/transvenous pacing
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1st degree heart block
Lengthened P-R interval > 0.2 sec (> 5 small
boxes)
Partial AV node block
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2nd Degree Heart Block
Mobitz Type I 2nd degree AV block
A cycle of progressive lengthening of PR interval followed by absence of QRS complex
Wenkebach Phenomeno
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*Mobitz Type II 2nd Degree Heart Block
Intermittent absence of QRS complex
(non-conducted P wave)
PR interval normal
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*Complete/ 3rd degree heart block
Variable conduction origins
Lack of synchronization between atria and
ventricles
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Take home message
Recognize ECG findings
Indications for defibrillation, cardioversion and
pacing
How to do it
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Thank you
Ref:
1. Tintinallis Emergency Medicine Manual, 7th Edition
2. AHA ACLS 2010; Electrical therapy
3. Basic and Advanced Life Support 2005 by K.S.Chew,
emergency department USM
4. ECG Teaching by Dr Effa, cardiologist, Medical faculty
UiTM
5. http://www.ecglibrary.com
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