Defibrillation, Synchronized Cardioversion and Automatic Internal Cardiac Defibrillators

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  1. What is Transthoracic resistance?
    • creates the energy needed to pass through skin, lungs and tissue 
    • you will transmit the energy through the chest wall
    • Single shocks need higher voltage 
    • Repeated shocks can use lower voltage
    • Myocardial cells rupture (elevated Troponin levels) with each shock and with higher voltage (Newer defibrillators are preset to lower voltage levels by giving multiple discharges/shock)
  2. What is biphasic shock?
    • Biphasic energy passes through both directions. This lowers the transthoracic resistance
    • require less energy to be used, salvage myocardial cells and convert rhythms at lower doses of joules
  3. When would you want to use the defibrillator?
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    • Vtac--> defib will depolarize all cells at once and hopefully fastest (SA) node will take over. 
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    • V-Fib. This would be a good one too. 
    • *Neither one is producing any cardiac output.
  4. What is Synchronized Cardioversion?
    • Dispenses shock when cells capable of transmission of current during ventricular repolarization 
    • Can use lower doses/voltage
    • Can be elective or emergent
    • Can use for atrial fibrillation/flutter (elective), or stable VT (has pulse and awake)
    • *need to have an R wave.
  5. Care for Cardioversion?
    • NPO 
    • Anticoagulate- may be thrombogenic
    • Informed Consent
    • IV access/ sedation if awake
    • Monitor HR, BP, RR. remove oxygen just prior to cardioversion
    • Known K+, Mg+ lab values
  6. Procedure for cardioversion?
    • Paddles require at least 25 # of pressure
    • Pads must seal to the chest (if not, shock can arch to NC and burn nose), AP (Anterior/Posterior) placement preferred to just anterior pad placement
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    • Call “Stand Clear” prior to shock
    • Repeat assessment and VS after procedure
    • Use ACLS trained professionals
  7. When/Why would you use an Automatic internal cardiac defibrillator (AICD)?
    • Used for sudden death due to heart attach (as opposed to trauma). (spontaneous ventricular tachycardia)
    • 􏰀 Used for pacing
    • 􏰀 Used for re-synchronization in Heart failure (4 chamber pacing) 
    • Can be reprogrammed via phone call. Freaky.
  8. How does an AICD work?
    • Senses fast rhythms by...
    • 􏰀 Measures QRS width for wide tachycardia
    • 􏰀 Monitors for high voltage (VT is usually very tall in amplitude)
    • 􏰀 watches for sustained rhythm (not salvos or NSVT)
    • 􏰀  charges the defib with low voltage
    • 􏰀  Discharges the defib
  9. Voltages for various form of Defibrillation?
    • Monophasic Defibrillation: 200, 300, 360
    • 􏰀 Biphasic Defibrillation: 120, 200, 240
    • 􏰀 Synchronized cardioversion: 50, 120, 150
    • 􏰀 AICD: 15 for six attempts then 25
  10. Nursing care for pt with AICD?
    • Do not defibrillate over pacer
    • 􏰀 Patient will feel shock
    • 􏰀 Others may/may not feel shock
    • 􏰀 Rhythms can be downloaded and examined
    • 􏰀 Frequent shocks require further medical work up and rhythm suppression
    • 􏰀 Prevent SVT at rates >150- they may be shocked because sometimes the PM cannot tell the difference.
  11. What safety education do you need to give pt?
    • What might you include in discharge instructions?
    • 􏰀  Can a patient die with an AICD? Of course. They are not immortal. 
    • 􏰀  What about airport metal detectors? microwave ovens? Metal detectors will be activated. Microwaves shouldn't be a problem, unless they're in one. 
    • 􏰀  Will they pass out with an activated AICD? No. The V-tac causes pt to pass out.
    • 􏰀  Are the patients electrically sensitive? No.
  12. How does a pacemaker work?
    Will stimulate "pace making" (usually in the ventricle) cells of heart in the absence of heart cell conductivity in the vicinity of the pacemaker electrode.
  13. What does a pacemaker look like on an ECG?
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    • PM is silent on auscultation.
  14. Anatomy of a pacemaker?
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    • If electrode goes bad, it stays in place and another is simply inserted somewhere else.
  15. What is pacer capture vs sense?
    • Capture: heart tissue picks up pacer electrical activity and carries it
    • Sense: Pacer Maker detects heart's own rhythm and does not fire.
  16. Read about nursing care for recovering cardiac PM pt.
    • Look for capture
    • Want it "scarred in." 
    • ECG complex will never look normal
Card Set:
Defibrillation, Synchronized Cardioversion and Automatic Internal Cardiac Defibrillators
2013-02-22 04:40:52

Adult MedSurg 2
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