Defibrillation, cardioversion and pacing
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This document discusses defibrillation, cardioversion, and pacing. It provides: 1) A brief history of defibrillation and its use for ventricular fibrillation and pulseless ventricular tachycardia. 2) An overview of cardioversion for treating unstable tachyarrhythmias with signs of low cardiac output, excessive heart rates, or chest pain. Synchronized cardioversion times shock delivery to the QRS complex. 3) Information on pacing for unstable bradyarrhythmias and symptomatic bradycardia, including complete heart block and Mobitz type II second-degree heart block.
Defibrillation, cardioversion and pacing
- 1. DEFIBRILLATION, CARDIOVERSION AND PACING By: dr ismah, A&E department 1
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- 7. 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 7
- 10. 10 Automated AED @ KLIA
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- 13. 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 13
- 14. Conditions Starting J (monophasic) AF 200 Atrial flutter 100 VT 200 SVT 100 14
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- 18. Pacing Unstable, bradyarrhythmias/bradycardia Symptomatic sinus bradycardia Heart block - Complete heart block - Mobitz type II 2nd degree heart block Transcutaneous/transvenous pacing 18
- 19. 1st degree heart block Lengthened P-R interval > 0.2 sec (> 5 small boxes) Partial AV node block 19
- 20. 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 20
- 21. *Mobitz Type II 2nd Degree Heart Block Intermittent absence of QRS complex (non-conducted P wave) PR interval normal 21
- 22. *Complete/ 3rd degree heart block Variable conduction origins Lack of synchronization between atria and ventricles 22
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- 25. Take home message Recognize ECG findings Indications for defibrillation, cardioversion and pacing How to do it 25
- 26. 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 26
Editor's Notes
- #3: Normal ecg
- #4: VF: Chaotic irregular deflections of varying amplitude No identifiable P waves, QRS complexes, or T waves Rate 150 to 500 per minute
- #5: VT: Wide QRS complex Tachycardia AV dissociation
- #6: Tachyarrhythmia:- AF: absence P wave, irregular rhythm Atrial flutter: saw tooth
- #7: Sinus bradycardia
- #9: Children: 2-4 J/kg
- #10: Off O2: prevent burn Pictures credit to: Basic and Advanced Life Support 2005 by K.S.Chew, emergency department USM
- #15: Cardioversion up to 3X Treat U/L cause Failed 1st cardioversion proceed IV amiodarone 300 mg loading over 20 min then try 2nd cardioversion
- #19: HR<40 Give atropine(0.5mg, max total 3mg)/adrenaline while preparing pacing