Defibrillation is performed to correct life-threatening fibrillations of the heart, which could result in cardiac arrest. It should be performed immediately after identifying that the patient is experiencing a cardiac emergency, has no pulse, and is unresponsive.
Defibrillation should not be performed on a patient who has a pulse or is alert, as this could cause a lethal heart rhythm disturbance or cardiac arrest. The paddles used in the procedure should not be placed on a woman's breasts or over a pacemaker.
Fibrillations cause the heart to stop pumping blood, leading to brain damage and/or cardiac arrest. About 10% of the ability to restart the heart is lost with every minute that the heart stays in fibrillation. Death can occur in minutes unless the normal heart rhythm is restored through defibrillation. Because immediate
defibrillation is crucial to the patient's survival, the American Heart Association has called for the integration of defibrillation into an effective emergency cardiac care system. The system should include early access, early cardiopulmonary resuscitation, early defibrillation, and early advanced cardiac care.
Defibrillators deliver a brief electric shock to the heart, which enables the heart's natural pacemaker to regain control and establish a normal heart rhythm. The defibrillator is an electronic device with electrocardiogram leads and paddles. During defibrillation, the paddles are placed on the patient's chest, caregivers stand back, and the electric shock is delivered. The patient's pulse and heart rhythm are continually monitored. Medications to treat possible causes of the abnormal heart rhythm may be administered. Defibrillation continues until the patient's condition stabilizes or the procedure is ordered to be discontinued.
Early defibrillators, about the size and weight of a car battery, were used primarily in ambulances and hospitals. The American Heart Association now advocates public access defibrillation; this calls for placing automated external defibrillators (AEDS) in police vehicles, airplanes, and at public events, etc. The AEDS are smaller, lighter, less expensive, and easier to use than the early defibrillators. They are computerized to provide simple, verbal instructions to the operator and to make it impossible to deliver a shock to a patient whose heart is not fibrillating. The placement of AEDs is likely to expand to many public locations.
After help is called for, cardiopulmonary resuscitation (CPR) is begun and continued until the caregivers arrive and set up the defibrillator. Electrocardiogram
After defibrillation, the patient's cardiac status, breathing, and vital signs are monitored until he or she is stable. Typically, this monitoring takes place after the patient has been removed to an intensive care or cardiac care unit in a hospital. An electrocardiogram and chest x ray are taken. The patient's skin is cleansed to remove gel or paste, and, if necessary, ointment is applied to burns. An intravenous line provides additional medication, as needed.
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American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. <http://www.americanheart.org>.
"AARC Clinical Practice Guideline: Defibrillation During Resuscitation." American Association of Respiratory Care. 29 Apr. 1998 <http://www.hsc.missouri.edu/~shrp/rtwww/rcweb/aarc/ddrcpg.html>.
"Defibrillation." American Heart Association. 1997. 9 Apr. 1998 <http://www.americanheart.org>.
Lori De Milto
Cardiac arrest—A condition in which the heart stops functioning. Fibrillation can lead to cardiac arrest if not corrected quickly.
Fibrillation—Very rapid contractions or twitching of small muscle fibers in the heart.
Pacemaker—A surgically implanted electronic device that sends out electrical impulses to regulate a slow or erratic heartbeat.