Defibrillation, cardioversion and pacing

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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