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Emergency management of the patient, Study notes of Medicine

Defibrillator: definition,purpose of defibrillator, indication,types of defibrillator brief contraindicated, complications,waves of defibrillator, electrodes position,type of lead , nursing interventions after defibrillation. Bag and mask ventilation Definition,type, difference between types, indication, contraindications, advantages, disadvantages, complications, Nursing diagnosis and intervention.

Typology: Study notes

2020/2021

Available from 04/10/2024

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DEFIBRILLATOR
DEFINITION
Defibrillation is a process in which an electronic device sends an electric shock
to the heart to stop an extremely rapid, irregular heartbeat, and restore the
normal heart rhythm.
Defibrillation is a common treatment for life threatening cardiac dysrhythmias –
1. Ventricular fibrillation(VF)
2. Pulseless ventricular tachycardia (PVT).
NEED FOR A DEFIBRILATOR.
1. VF/pVT – asynchronous rapid ineffective contraction of the heart.
2. Early defibrillation – high chance of rhythm to revert back to normal.
DEFIBRILLATION WAVEFORMS AND ENERGY
LEVELS
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DEFIBRILLATOR

DEFINITION

Defibrillation is a process in which an electronic device sends an electric shock to the heart to stop an extremely rapid, irregular heartbeat, and restore the normal heart rhythm. Defibrillation is a common treatment for life threatening cardiac dysrhythmias –

  1. Ventricular fibrillation(VF)
  2. Pulseless ventricular tachycardia (PVT).

NEED FOR A DEFIBRILATOR.

  1. VF/pVT – asynchronous rapid ineffective contraction of the heart.
  2. Early defibrillation – high chance of rhythm to revert back to normal.

 DEFIBRILLATION WAVEFORMS AND ENERGY

LEVELS

 The energy settings are designed to provide the lowest effective energy needed to terminate VF  Shock success -Termination of VF at 5 seconds after the shock  VF frequently recurs after successful shocks, but this recurrence should not be equated with shock failure  Based on energy delivery, defibrillators are classified as:- Monophasic Biphasic  Energy levels vary by type of device Monophasic – (360 J) Biphasic- (120-200J)  .In pediatrics Use of pediatric paddle Doses are 2-4 J/kg upto a maximum of 10J/kg with subsequent shocks.

Synchronized Cardioversion

 Tachyarrhythmias with pulse, but an unstable patient.  Energy selection is from 50-200 J.  ECG leads must be attached to the defibrillator, paddles/pads attached and ‘sync’ button pressed.  Following synchronization, the device is charged and shock delivered.

  • AED delivers shock to a patient after it identifies pulseless ventricular tachycardia and ventricular fibrillation.
  • The device has two electrodes (pads) so it has to be positioned over clean and dry skin. Position of electrodes is same as that of Direct current Defibrillator.
  • These electrodes sense the electrical activity of heart and analysis the rhythm. If the rhythm is a shockable one, the device gives visual and auditory signals and provides direction to the lay person to deliver shock.

3.AUTOMATIC IMPLANTABLE CARDIOVERTER

DEFIBRILLATOR.

The AICD is a device that delivers electric shock directly to the heart muscles in order to terminate lethal dysrhythmias.

It has a pulse generator and a sensor that continuously monitor rhythm and detects dysrhythmias. It automatically delivers a counter shock.

  • AICD is surgically implanted by lateral thoracotomy or median sternotomy,in subxiphoid or subintercostal regions.

 WORKING OF AED

 Turned on or opened AED.  AED will instruct the user to:-  Connect the electrodes (pads) to the patient.

  • Avoid touching the patient to avoid false readings by the unit.  The AED analyses rhythm and determines if shockable or not.  When device determined that shock is warranted, it Will charge its internal capacitor in preparation to deliver the shock.  When charged, the device instructs the user to ensure No one is touching the victim and then to press a red button to deliver the shock. They come with a pediatric dose attenuator for children < 8

 PRECAUTION

 The paddles used in the procedure:  Should not be placed on a breasts  Over an internal pacemaker generator.  Over wet/hairy skin  Before the paddle is used, a conducting jelly must be applied and spread over the electrode surface.

CARE AFTER DEFIBRILATION

The patient’s cardiac status, breathing, and vital signs are monitored until he or she is stable. 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.

 COMPLICATIONS

  1. Damage to mayocardium due to repeated high energy electrical shocks.
  2. 2.Chest burns due to repeated high energy discharge and poor contact between the paddles and the skin

ventilation in the operation theatre when intubation is not required, but it is now often substituted by the laryngeal mask airway.

PARTS OF BMV

The BMV consists of

  1. The bag a flexible air chamber, attached to a face mask via a shutter valve which is squeezed to expel air to the patient. Mask: a flexible mask to seal over the patients face,
  2. Filter and valve: a filter & valve prevent backflow into the bag itself (prevents patient deprivation and bag contamination)
  3. Oxygen Reservoir:
  4. Pressure Gauge
  5. Oxygen Connecting tube
  6. Provide a volume of 6-7 mL/kg per breath (approximately 500 mL for an average adult)
  7. For a patient with a perfusing rhythm, ventilate at a rate of 10 12 breaths per minute.
  8. • Adult size: 2 litres, Paediatric size:500 ml

TYPES OF BAG USED

1.Flow inflating bag (Anaesthesia Bag)Fills only when oxygen from a compressed source flows into it Depend on a compressed gas source Must have a tight face-maskSeal to inflateUse a flow-control valve to regulate pressure-inflation.

2.Self inflating bag (AMBU Bag)

 Fill spontaneously after they are squeezed. Pulling oxygen or air into the bag  Remain inflated at all times  Can deliver positive-pressure ventilation without a compressed gas source.  Require attachment of an oxygen reservoir to deliver 100% oxygen

 Respiratory failure

 Failure of ventilation

 Failure of oxygenation

 Failed intubation

 Elective ventilation in the operating room

 PROCUDURE

 One hand to

 Maintain face seal

 Position head

 Maintain patency

 Other hand for ventilation

 BMV TECHNIQUE

 “Sniffing”position if C-spine OK

 Thumb + index finger to maintain face seal

 Middle finger under mandibular symphysis

 Ring and little finger under the angle of mandible

Lung injury from over-stretching (called volutrauma)

Lung injury from over-pressurization (called

barotrauma)

Lung aspiration

Air Embolism

o NURSING MANAGEMENT:

1. Promote respiratory function.

2. Monitor for complications

3. Prevent infections.

4. Provide adequate nutrition.

5. Monitor GI bleeding