Defibrillation

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Safety

• Defibrillation may be associated with a risk of explosion as well as electrocution of rescuers. In order to minimize these risks take the following precautions.

• If the patient is not intubated remove any oxygen delivery devices and place them ≥ 1 m from patient’s chest

• If the patient is intubated

  • either leave bag valve resuscitator attached to endotracheal tube

  • or remove and place ≥ 1 m from patient’s chest

• Use self-adhesive defibrillation pads, if available, rather than paddles

• Do not place pads or paddles over implantable pacemakers or automatic implantable cardioverter defibrillators to avoid damage to these devices

• Remove transdermal nitrate patches

• Give a clear verbal warning to other rescuers to stand clear AND confirm visually that all rescuers are clear before defibrillation

Procedure

• Attach self-adhesive pads or water-based gel pads to the chest without interrupting chest compressions. Place sternal pad to the right of the sternum, below the clavicle. Place the apical pad in the mid-axillary line, approximately level with the 5th intercostal space or the female breast. It is important that the apical pad is placed sufficiently laterally. If the chest is very hairy shave the area intended for pad placement IF a razor is immediately available

• Charge defibrillator to appropriate energy

• If using paddles apply them firmly over gel pads

• Warn other rescuers to stand clear

• Visually check that all other rescuers are clear

• Ensure you are not touching the patient or the bed

• Deliver shock

• Restart chest compressions without checking for a pulse

Video

• Using the defibrillator as a monitor
• Demonstration of safe use of defibrillator with paddles
• Demonstration of safe use of defibrillator with self-adhesive pads
• Demonstration of resuscitation from VF arrest (with paddles)
• Demonstration of resuscitation from VF arrest (with pads)

©Charles Gomersall, October, 2009 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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